Construction and Evaluation of a 2 mm-Diameter Artificial Artery via a Cross-Linked Acellularized Matrix

Constructing clinically viable tiny-diameter vascular grafts (inner diameter <3 mm) remains challenging. Here, we developed a dual-cross-linking strategy using oxidized chitosan (OCS) and oxidized konjac glucomannan (OKGM) to modify acellularized porcine peritoneum (APP), fabricating 2 mm-diameter grafts via spiral wrapping and microsuture, replicating native artery topography. Evaluations showed enhanced hemocompatibility, antithrombotic properties, endothelial compatibility, mechanical strength matching native vessels, anticalcification, component stability, antibacterial efficacy, and controlled in vivo immune responses. One-year rabbit abdominal aorta implantation yielded 90% patency, complete endothelialization, elastic lamina/neointima regeneration, no thrombosis/infection/aneurysm, and functional integration via Doppler ultrasound. These findings collectively demonstrate that OCS/OKGM-modified APP grafts represent a transformative solution for tiny-diameter vascular reconstruction, showing substantial clinical translation potential to address current limitations in vascular tissue engineering.