Purpose To evaluate the effect of transarterial embolization (TAE) on tumor burden, renal function, and safety in renal angiomyolipoma (AML) and to identify drivers of between-study heterogeneity. Materials and Methods A systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and prospectively registered in PROSPERO. Major databases were searched through January 2024. Morphologic response was expressed as percentage reduction from baseline (random-effects ratio of means; medians converted by Wan method); proportions were pooled by arcsine transformation. Risk of bias was assessed with risk of bias in nonrandomized studies of interventions, risk of bias 2, and the Joanna Briggs Institute checklist. Results In total, 79 studies (1,798 patients) were included. TAE reduced tumor volume by 55.7% (95% confidence interval [CI], 49.3%–61.3%; I2 = 85.6%; k = 18) and diameter by 34.2% (95% CI, 29.1%–38.9%; I2 = 70.1%; k = 43). The interval to postprocedural imaging accounted for 50.7% of the between-study variance in volume reduction (P = .002); predicted reduction increased from 44% at 1 month to 63% at 36 months, a gradient 3 cohorts with serial imaging reproduced within study. Serum creatinine and estimated glomerular filtration rate showed no clinically meaningful change from baseline. Pooled technical and clinical success were 98% and 97%; adverse events other than postembolic syndrome occurred in 3% and postembolic syndrome in 46%. Conclusions TAE achieved substantial, strongly time-dependent tumor reduction with high procedural success and few adverse events. Renal function was stable relative to baseline, but no included study used a surveillance comparator. Standardized outcome definitions and prespecified imaging intervals are needed before pooled estimates can guide patient selection.
