Artificial Vasa‐Vasorum Serves as an On‐Site Regenerative Promoter of Cell‐Free Vascular Grafting

Abstract The control paradigm of small vessel pathophysiology has changed to focus on the vascular out‐wall rather than the lumen‐intimal factors. As an emerging controller of the external wall, the microvasculature (“vasa vasorum”) provides interactional routes between the in‐and out‐sides of the vascular wall. Despite numerous approaches to developing small‐diameter vascular grafts, engineering artificial vasa vasorum (AVV) has not been projected as a multi‐functional solution to address long‐standing issues such as thrombotic and immune controls for wall regeneration. Here, the AVV is engineered using a microchannel network hydrogel after a multi‐study validation of implantation functions and then used to wrap the external wall of the cell‐free vessel post‐decellularization while preserving its mechanical properties. Upon inter‐positional and bypass grafting to rabbit arteries, the AVV graft facilitates the recruitment of vascular cells into the cell‐free wall by promoting invasion of angiogenic and vasculogenic cells through the microchannel‐mediated M2 polarization of macrophages. This function results in the efficient restoration of smooth muscle cells, and the revitalized vascular elasticity helps to maintain long‐term patency. The AVV, therefore, serves as an effective catalyst for vascular wall regeneration, offering a solution to clinically successful small‐diameter vascular grafting.