Advances in Polyester Vascular Grafts: Design, Performance, Biocompatibility, and Emerging Innovations

Cardiovascular diseases (CVDs) are the leading cause of death globally, underscoring the importance of surgical interventions such as vascular grafts in restoring blood flow and managing vascular diseases. Polyester vascular grafts have been a staple in CVD treatment for over six decades due to their mechanical durability and ease of handling. However, issues like thrombogenicity, compliance mismatch, and susceptibility to infection persist, prompting the need for innovation in graft design and material properties. The review focuses on examining the evolution of polyester vascular grafts, addressing limitations, and exploring advanced modifications to improve clinical outcomes. This review aims to evaluate the development, clinical applications, and material advancements associated with polyester vascular grafts. It will analyze their mechanical and biological performance, compare them with other graft types, and explore potential improvements in design and surface modification to address current limitations. While the review does not provide specific details on the literature search strategy, it likely involved synthesizing existing research from clinical studies, material science advancements, and innovations in graft design. Key references are included to support the comparative analysis of polyester grafts and emerging technologies. Polyester vascular grafts, especially in large-diameter applications, offer long-term patency and mechanical reliability. However, they face challenges such as infection, thrombogenicity, and mechanical mismatch with native vessels. Recent advancements, including hybrid grafts, drug-eluting coatings, and electrospun nanofiber scaffolds, are explored for their potential to enhance graft integration, biocompatibility, and resistance to microbial colonization. Furthermore, emerging technologies like personalized 3D-printed grafts and smart grafts with biosensors hold promise for future vascular therapies. Polyester vascular grafts remain crucial in vascular surgery, yet significant room for improvement exists. Future advancements, particularly in hybrid, bioactive, and smart grafts, could address current challenges, offering more personalized and effective solutions for complex vascular conditions. The ongoing integration of material sciences, tissue engineering, and personalized medicine will likely drive the next generation of vascular grafts.