*Review* **Future Perspectives in Small-Diameter Vascular Graft Engineering**

**Panagiotis Mallis 1,\*, Alkiviadis Kostakis 2, Catherine Stavropoulos-Giokas 1 and Efstathios Michalopoulos 1**


Received: 25 October 2020; Accepted: 9 December 2020; Published: 10 December 2020

**Abstract:** The increased demands of small-diameter vascular grafts (SDVGs) globally has forced the scientific society to explore alternative strategies utilizing the tissue engineering approaches. Cardiovascular disease (CVD) comprises one of the most lethal groups of non-communicable disorders worldwide. It has been estimated that in Europe, the healthcare cost for the administration of CVD is more than 169 billion €. Common manifestations involve the narrowing or occlusion of blood vessels. The replacement of damaged vessels with autologous grafts represents one of the applied therapeutic approaches in CVD. However, significant drawbacks are accompanying the above procedure; therefore, the exploration of alternative vessel sources must be performed. Engineered SDVGs can be produced through the utilization of non-degradable/degradable and naturally derived materials. Decellularized vessels represent also an alternative valuable source for the development of SDVGs. In this review, a grea<sup>t</sup> number of SDVG engineering approaches will be highlighted. Importantly, the state-of-the-art methodologies, which are currently employed, will be comprehensively presented. A discussion summarizing the key marks and the future perspectives of SDVG engineering will be included in this review. Taking into consideration the increased number of patients with CVD, SDVG engineering may assist significantly in cardiovascular reconstructive surgery and, therefore, the overall improvement of patients' life.

**Keywords:** small-diameter vascular grafts; tissue engineering; cardiovascular disease; vascular reconstruction; bypass surgery; decellularization; human umbilical arteries; synthetic materials; 3D and 4D printing; thermoresponsive materials
