Advancements in the fabrication technologies and biomaterials for small diameter vascular grafts: A fine-tuning of physicochemical and biological properties

Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide. Autografts are gold-standard treatment options. However, their use is hampered by several limitations, such as donor-site associated immunogenicity, thrombosis, intimal hyperplasia (IH), and stenosis. Synthetic vascular grafts have the potential for large-diameter blood vessel reconstruction; nevertheless, they often fall short when grafted as small diameter substitutes. Small-diameter vascular grafts often fail due to thrombosis and IH. Significant strides have been made in the treatment of CVDs due to the rapid development of fabrication technologies of small diameter blood vessels (SDBVs) and the use of diverse biomaterials that enable the creation of SDBVs with the capacity to integrate, remodel, and heal in vivo. Despite several publications on the use of various biomaterials in the creation of SDBVs, there is a significant paucity of expertise and literature on natural and synthetic polymer-based SDBV fabrication processes. In this review, we aim to summarize different types of fabrication technologies that have been leveraged for SDBV fabrication as well as discuss their merits and demerits. The most recent and relevant accomplishments have been further highlighted. In addition, we provide perspectives on current challenges, future development opportunities, and new directions. Continuous progress in SDBV manufacturing is predictable, implying that the clinical application of SDBVs will become a reality in the near future.