Objective: To compare long-term tumor control and renal function outcomes of Selective transarterial embolization (TAE) for large renal angiomyolipoma (AML ≥10 cm) performed prophylactically versus emergency embolization for acute hemorrhage.

Methods: This retrospective single-center study included 44 patients (46 large renal AMLs) treated with selective TAE between July 2018 and June 2024. Mean tumor size was 13.2 ± 3.12 cm, with a mean follow-up of 25.2 months. Patients were divided into a prophylactic embolization group (n = 34) and an emergency embolization group (n = 10). Primary outcomes were radiologic tumor size reduction and renal function preservation assessed using serum creatinine and estimated glomerular filtration rate (eGFR). Secondary outcomes included reintervention, hospital stay, and post-embolization complications.

Results: Mean tumor size significantly decreased from 13.2 cm pre-embolization to 10.3 cm post-embolization (p = 0.003), with no significant difference between prophylactic and emergency groups (p > 0.05). Renal function remained stable with no significant change in serum creatinine or eGFR (p = 0.6 and p = 0.8). Reintervention rates were higher after emergency embolization but were not statistically significant (20.0% vs. 11.8%, p > 0.05). Hospital stay was significantly longer in the emergency group (3.5 ± 1.2 vs. 1.8 ± 0.8 days, p < 0.05). Post-embolization syndrome was the most common complication (43.1%).

Conclusion: Selective TAE provides durable tumor control and preserves renal function in large renal angiomyolipoma. While radiologic outcomes are comparable, emergency embolization is associated with prolonged hospitalization, supporting early prophylactic treatment.