Challenges and Strategies for Endothelializing Decellularized Small‐Diameter Tissue‐Engineered Vessel Grafts

Abstract Vascular diseases are the leading cause of ischemic necrosis in tissues and organs, necessitating using vascular grafts to restore blood supply. Currently, small vessels for coronary artery bypass grafts are unavailable in clinical settings. Decellularized small‐diameter tissue‐engineered vessel grafts (SD‐TEVGs) hold significant potential. However, they face challenges, as simple implantation of decellularized SD‐TEVGs in animals leads to thrombosis and calcification due to incomplete endothelialization. Consequently, research and development focus has shifted toward enhancing the endothelialization process of decellularized SD‐TEVGs. This paper reviews preclinical studies involving decellularized SD‐TEVGs, highlighting different strategies and their advantages and disadvantages for achieving rapid endothelialization of these vascular grafts. Methods are analyzed to improve the process while addressing potential shortcomings. This paper aims to contribute to the future commercial viability of decellularized SD‐TEVGs.