An overview of small diameter vascular grafts: from materials to fabrication

Small-diameter vascular grafts (SDVGs, inner diameter ≤6 mm) are in urgent demand for treating severe vascular diseases, such as coronary and peripheral artery diseases, where autologous grafts are often unavailable. Despite the clinical success of large-diameter vascular grafts (LDVGs), SDVGs face significant challenges, including poor biocompatibility, high thrombosis risk, and inadequate mechanical properties, limiting their widespread application. Recent advances in biomaterials—ranging from synthetic polymers to decellularized scaffolds—have sought to address these limitations, yet each material presents trade-offs in durability, immunogenicity, and regenerative potential. Furthermore, innovative fabrication techniques, such as electrospinning and 3D printing, have improved graft performance but struggle with scalability and long-term patency. In this review, we systematically evaluated the current materials used for the fabrication of SDVGs and classified them based on degradability (degradable vs. non-degradable) and origin (biological materials vs. synthetic polymers), providing a comprehensive comparison of their utility in SDVG applications. Furthermore, we conducted a detailed elaboration and comparative analysis of various fabrication techniques, including cell sheet engineering, molding, bioreactor, bioprinting, and others. Most importantly, we provide clinical insights into overcoming current barriers, proposing strategies for enhancing hemocompatibility, endothelialization, and mechanical resilience to accelerate the translation of SDVGs into real-world practice.