Engineering Vascular Grafts: The Intersection of Manufacturing Techniques and Immune Response Modulation

Cardiovascular disease is the leading cause of mortality worldwide. The most common treatment option is bypass grafting surgery, and the success of this procedure depends on the availability and performance of the vascular graft. Autologous grafts are considered the gold standard; however, they are limited by donor site morbidity and availability. Synthetic grafts are used as an alternative solution; however, they often result in complications due to poor integration and disparate mechanical properties. To overcome these limitations, a deep understanding of both the native vascular structure and the complex host immune response to implanted materials is needed. This review highlights the importance of integrating engineering and immunological strategies to develop the next-generation vascular grafts. It examines different manufacturing techniques that have been used to fabricate vascular scaffolds and assesses their ability to produce scaffolds that closely mimic native blood vessels. Additionally, this review highlights the critical role of the immune system by focusing on the involvement of key phagocytes as well as examining how surface topography and the incorporation of bioactive molecules can modulate immune cell behavior and promote graft integration. Ultimately, interdisciplinary research is essential to optimize graft-host interactions, predict graft outcomes, and translate innovative solutions into clinical practice. As a result, these advances have the potential to improve bypass grafting outcomes and enhance patient quality of life.