Purpose <p>To assess the rates of success, complications, and re-interventions of selective arterial embolisation of renal angiomyolipomas.</p> Materials and Methods <p>A systematic review and meta-analysis was conducted, including studies reporting outcomes of selective arterial embolisation for renal angiomyolipomas. Pooled estimates were calculated for technical success, radiological success, clinical success, tumour shrinkage, re-embolisation rates, surgical re-intervention, and complication rates. Heterogeneity was assessed using I² statistics. Exploratory regression modelling was performed to assess factors associated with re-intervention.</p> Results <p>Thirteen studies comprising 478 patients and 542 AMLs were included. Technical success—successful delivery and occlusion of the embolic agent—was achieved in 86.2% of cases (95% CI 80–89.1%; I² = 36.1%). Radiological success, based on CT-assessed tumour shrinkage, was observed in 94% of cases (95% CI 91.2–97.3%; I² = 15.6%). Subgroup analysis revealed ethanol-alone embolisation achieved the highest shrinkage (95.8%) and the lowest re-intervention rate (3.4%). Pooled re-intervention (re-embolisation or surgery) was required in 19% of cases (95% CI 10–34%; I² = 85.9%). Minor complications occurred in 46% of procedures, predominantly post-embolisation syndrome (PES, 43%; 95% CI 35–53%; I² = 88.8%). Major complications, such as retroperitoneal bleeding, significant haematuria, abscesses, or prolonged hospital admission, were rare (pooled rate: 5.7%; 95% CI 3.9–8.2%), and the pooled rate for surgical re-intervention was 4% (95% CI 2–7%) with low heterogeneity (I² = 9.6%; <i>p</i> = 0.333).</p> Conclusion and Contribution <p>Embolisation is a safe primary treatment option for renal angiomyolipomas with high technical and radiologic success, low major complications, and rates of surgical intervention. Embolic agent choice significantly impacted outcomes in this cohort.</p> Graphical Abstract <p></p>