A 44-year-old morbidly obese man with ventral hernia repair 3 weeks prior presented to the Emergency Department with 48 h of progressive dyspnea at rest and with exertion. One week prior to presentation, the patient noted right calf cramping with ambulation. He attributed this to being relatively sedentary since his surgery. On physical examination, he was tachycardic to 130 beats per minute, hypotensive with a blood pressure of 82/44 mmHg, and hypoxemic with an oxygen saturation of 88 % on room air. His electrocardiogram was notable for sinus tachycardia to the 130 s. His chest X-ray demonstrated a small left pleural effusion. Contrast-enhanced chest computed tomogram (CT) demonstrated a large bilateral PE and right ventricular (RV) enlargement with an RV diameter-to-left ventricular (LV) diameter ratio of 1.4. In the Emergency Department, the patient’s blood pressure increased to 100/68 mmHg following a 1 L normal saline bolus. He was started on intravenous unfractionated heparin as a bolus and then continuous infusion with a target activated partial thromboplastin time (aPTT) of 60–80 s. Right lower extremity venous ultrasound demonstrated common femoral, femoral, popliteal, gastrocnemius, peroneal, and posterior tibial DVT. Because of the large reservoir of thrombus in the patient’s right lower extremity and the concern that a subsequent PE might be fatal, the Emergency Department physician consulted the hospital’s multidisciplinary PE Response Team. The PE Response Team determined that a fibrinolytic based approach was contraindicated given his recent surgery and that his morbid obesity increased the operative risk of surgical pulmonary embolectomy. Therefore, the PE Response Team arranged for a retrievable IVC filter to be placed in the Cardiac Catheterization Laboratory (Fig. 8.1). After insertion of the IVC filter, the patient was admitted to the Intensive Care Unit and then transferred to a floor bed the following day. He remained hemodynamically stable, and his dyspnea and hypoxemia resolved on therapeutic anticoagulation. He was subsequently discharged on oral anticoagulation with warfarin and arranged to follow-up in Vascular Medicine clinic. Six weeks after hospital discharge, he had fully recovered, and his Vascular Medicine physician arranged for IVC filter retrieval (Figs. 8.2, 8.3, and 8.4).