PURPOSE: To examine the safety of pulmonary angiography with low-osmolar contrast material and modern angiographic techniques and to analyze periprocedural complications with respect to potential predictors. PATIENTS AND METHODS: A retrospective review was conducted of data from 547 consecutive patients who underwent pulmonary angiography. Minor and major complications were analyzed by using several clinical parameters. RESULTS: There were five major (0.9%) and 26 minor complications (4.8%). Eleven of the 26 minor complications were contrast-induced nephrotoxicity. There were no periprocedural deaths. Patients with complications had an increased incidence of coexistent pulmonary morbidities and were of a poorer physical status according to the American Society of Anesthesiology criteria. Moderate to severe pulmonary hypertension was correlated with major complications. Age, volume of contrast material used, and presence of pulmonary embolism were not correlated with complications. CONCLUSION: Pulmonary angiography is a safe procedure with an acceptable complication rate. These findings should be considered in the selection of an imaging method for the diagnosis of pulmonary embolism. © SCVIR, 1996.