Therapeutic strategies for small-diameter vascular graft calcification

The incidence of cardiovascular disease is on the rise, and vascular reconstruction is an effective method for treatment. Small-diameter vascular grafts (SDVGs) are commonly used in reconstructive surgery, but they face significant challenges such as rapid endothelialization, antithrombotic formation, and calcification. Little research has been conducted on post-implantation calcification, a pathological process that occurs in vascular grafts. Calcification may contribute to vascular graft implantation failure. Comprehending the basic mechanisms of vascular graft calcification is crucial to achieve long-term transplantation success. In the present review, we summarized the calcification mechanisms of native vascular and the causes of SDVG calcification, which sources decellularized extracellular matrix (dECM) and polymer materials. At the same time, different strategies to prevent or delay calcification on SDVGs are reported (optimize cross-linking method, surface modification, large pore size, reduced inflammatory response). In addition, a review of anti-calcification methods in other biomaterials was also discussed, with the hope of applying them to SDVGs. This review might be helpful for researchers in designing the anti-calcification SDVGs.