Treatment of large symptomatic renal angiomyolipomas (AMLs) in patients with a solitary kidney poses a challenge in controlling the tumor while preserving renal function. This retrospective research examines the safety and long-term effects of transarterial embolization (TAE) using iodized oil-bleomycin emulsion plus N-Butyl cyanoacrylate (NBCA) for treating large symptomatic AMLs in patients with a solitary kidney.Over 20 years, 12 female patients, who had a solitary kidney due to a previous radical nephrectomy for AMLs, underwent TAE. Indications included symptomatic AMLs (retroperitoneal hematoma, hematuria or flank pain) and patients considered very high-risk for surgery (≥5 cm). The study evaluated adverse events (AEs), renal function changes, symptom relief, and tumor size.The median follow-up was 96 months. No significant kidney function decline was noted. Symptoms resolved completely in all patients, with the mean lesion diameter reducing from 7.2 ± 2.5 cm to 0.7 ± 0.5 cm (p < 0.01). Complete resolution (CR) of AMLs occurred in nine patients (83.3%), with no recurrence during follow-up.TAE with iodized oil-bleomycin emulsion plus NBCA for treatment with large symptomatic AMLs in solitary kidney is safe and durability effect, with complete resolution of the symptoms, high rate CR of the tumors, without deterioration of the renal function.ChiCTR2100053296.