ObjectiveTo compare the outcomes of dual-vessel intervention (DVI), including bronchial arterial embolization (BAE) and pulmonary arterial angiography/embolization (PAA/E), with those of BAE alone in managing massive hemoptysis caused by cavitary lung lesions.MethodThis multicenter, prospective trial enrolled patients with massive hemoptysis, who were assigned to either the DVI or BAE group. The endpoint included the hemoptysis recurrence rate, technical and clinical success rates. Risk factors for hemoptysis recurrence and the anatomic basis were analyzed.ResultsA total of 75 patients (37 in the DVI group,38 in the BAE group) with a mean age of 59.8 ± 10.4 years were enrolled. On average, 3.32±3.81 vessels were identified as culprit vessels in each patient, with a mean diameter of 3.18±1.24 mm. The most common ectopic vessel was the intercostal artery, followed by subclavian artery branches. Overall, the fistula rate was 80%, and the most common fistula was between the bronchial and pulmonary arteries. The technical and clinical success rates were greater in the DVI group without statistical significance. However, the recurrence rate was marginally significantly lower in the DVI group (8.6%) than in the BAE group (26.5%) (P=0.056). Aspergilloma was associated with a significantly greater risk of hemoptysis recurrence (P=0.006). Increased microvessels, occlusive pulmonary vessels, unbalanced hypertrophic bronchial and pulmonary arteries and Singular-millimetric-fibrovascular (SiMFis) -like lesion were detected in lung cavitary specimens.ConclusionsDVI is more effective than BAE in the management of massive hemoptysis caused by cavitary lesions. Many culprit vessels with enlarged diameters and a high ratio of vascular fistula of cavitary lesions were detected. The high proportion of fistulas on pulmonary angiography could be partly attributed to the presence of SiMFis-like lesion.