OBJECTIVE To evaluate the efficacy of selective transcatheter arterial embolization (TAE) in renal angiomyolipoma (AML) spontaneous ruptures with hemorrhage.METHODS A retrospective evaluation was carried out in 21 renal AML cases with acute bleeding confirmed by imaging. Selective renal arterial embolization was used to control bleeding. All the cases were detected by renal arteriography had abnormal vascular hyperplasia and enlarged blood vessels. RESULTS Initial renal arteriography for all the patients showed that tortuous, hypervascular, and aneurysm-forming angiogenic components with aneurysm formation occurred in 13 cases (61.9%)and extravasation of the contrast agent was found in 8 cases (38.1%). Immediate complete obliteration was technically successful in 19 (90.5%) of the 21 patients. To prevent uncontrollable complications, 3 patients received nephron-sparing surgery after hemodynamic status was stabilized with TAE a week later. Two days and 3 days after the embolizations, 2 patients presented with incomplete embolizations and then underwent nephrectomy when they were in a stable condition. There were no significant differences in the plasma creatinine levels before and after the treatment. All the patients were followed up for 6 months to 6 years (median, 45 months). The largest tumor diameter was reduced from (11.57?4.28) cm to (9.57?2.28) cm. The tumor had no blood supply and no relapses have occurred.CONCLUSION TAE is a technically feasible and minimally invasive procedure for ruptured renal angiomyolipoma. The aneurysms were a predictor of renal AML spontaneous rupture and detection of such aneurysms by CT may help to determine the timing of embolization. In patients who still need surgical treatment, TAE can make tumor resection easier to perform and reduce blood loss during the operation.