Acute pulmonary embolism carries a significant risk of morbidity and mortality. Surgical pulmonary embolectomy is rarely performed in contemporary practice, but it remains an important rescue option when thrombolytic or transcatheter therapies are contraindicated or not feasible. We report a case of acute pulmonary embolism caused by migration of vertebroplasty material into the inferior vena cava, requiring emergency surgical treatment. We describe the clinical presentation, diagnostic work-up, surgical management, and post-operative outcome of a 70-year-old woman who developed acute pulmonary embolism after vertebroplasty complicated by migration of silicone material into the inferior vena cava. Given the nature and location of the embolic material, surgical pulmonary embolectomy was selected as the definitive treatment strategy. Emergency surgical embolectomy was successfully performed, allowing removal of the embolic material and restoration of pulmonary vascular flow. The patient tolerated the procedure without major intraoperative complications. Post-operative recovery was favorable, with hemodynamic stabilization and no evidence of recurrent embolic events during follow-up. This case highlights the role of surgical pulmonary embolectomy as a lifesaving treatment in selected patients with acute pulmonary embolism, particularly when the embolic source is non-thrombotic and not amenable to pharmacological or catheter-based therapies. Early recognition of this rare complication and prompt multidisciplinary decision-making are essential to optimize outcomes.