New sustainable, cost-effective solutions are urgently needed for river management since conventional practices have posed serious ecological threats on streams, rivers and the surrounding riparian areas. Besides addressing the societal needs e.g. for flood management, river management should increasingly address the ecosystem requirements for improved water quality and biodiversity. We argue that it is not feasible to solve existing and future river management challenges with intensive restoration projects. Instead, we believe that less resource-intensive solutions using natural channel processes and features, including vegetation, should be investigated. Besides directly supporting biota, aquatic and riparian vegetation traps, takes up and helps to process nutrients and harmful substances, and thus this paper emphasizes vegetation as a tool for nature-based solutions (NBS) in river management. We synthesize findings from key literature, showing that the fate of substances in channel systems is largely controlled by abiotic and biotic processes facilitated and modified by vegetation, including flow hydrodynamics, channel morphology, and sediment transport. Subsequently, we demonstrate how vegetation can be incorporated into channel designs, focusing on a two-stage (compound) design to improve resilience to flooding, control the transport of substances, and enhance the ecological status. As a conclusion, clever use and maintenance of vegetation present an unused potential to obtain large-scale positive environmental impacts in rivers and streams experiencing anthropogenic pressures.