Synthetic and Tissue-Engineered Vascular Grafts: Current Status, Emerging Technologies, and Clinical Prospects

Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide, creating an urgent demand for small-diameter vascular substitutes with durable long-term patency. Large-caliber synthetic grafts, such as polyethylene terephthalate (PET) and ePTFE, are well established in clinical practice; however, these synthetic grafts fail in small-diameter applications due to thrombosis and intimal hyperplasia. Moreover, autologous grafts are constrained by limited availability and variable quality. Recently, synthetic degradable polymers (e.g., polycaprolactone (PCL), poly(lactic-co-glycolic acid) (PLGA)), and extracellular matrix-derived natural materials (collagen, gelatin, silk fibroin, bacterial cellulose) have drawn increasing attention, as each offers distinct advantages and limitations in terms of mechanics, biocompatibility, and degradation behavior. Meanwhile, emerging fabrication technologies, including electrospinning, thermally induced phase separation, microfluidic spinning, and three-dimensional printing, are advancing the structural biomimicry and functional optimization of artificial vascular grafts. Thus, building on these developments, this review further examines the design strategies of tissue-engineered vascular grafts (TEVGs), focusing on cell sourcing, <i>in vitro</i> and <i>in situ</i> endothelialization, antithrombotic modification, and the prevention of intimal hyperplasia, while also summarizing outcomes from preclinical models and early clinical trials. Despite promising progress, the widespread clinical translation of TEVGs remains limited by prolonged manufacturing cycles, high costs, and insufficient long-term patency. Hence, future efforts toward standardized cell sources, integrated structure, function design, and multicenter clinical validation are critical to the development of next-generation vascular grafts.