PULMONARY EMBOLISM Why treat? Options and Outcomes Acute pulmonary embolism (PE) is a common presentation worldwide. Up to 45% of patients with PE develop right ventricular (RV) dysfunction, subsequent haemodynamic compromise and death can occur if revascularisation is not rapidly provided. Despite the creation of Pulmonary Embolism Response Teams (PERT), a mortality rate of 41% at 3 months was reported in 2018. Furthermore, long term functional impairment has been reported to affect at least 18% of survivors. Australian data from 2008 estimated the cost of VTE to be $1.72 BILLION (0.15% OF GDP)of this: 1.38 billion (80.0%) was productivity lost to morbidity and mortality of young Australians. In the presence of haemodynamic compromise, current guidelines suggest that anticoagulation alone is inadequate and recommend systemic thrombolysis (ST), catheter-directed thrombolysis (CDT) or open thrombectomy, depending on local expertise and resources. ST is the first line option for most centres due to its availability and fast action, however, it is associated with 9.2% major bleeding and 1.5% intracranial hemorrhage. In addition, because of frequent thrombolytic contraindications and medical comorbidities, less than 30% of high-risk PE patients receive systemic thrombolysis. The need for prompt, safe and effective thrombus removal is evident. We present our experience building a Vascular Surgery led PERT, our protocols, device selection and outcomes.