Cardiovascular diseases are the leading cause of mortality around the globe. The development of a functional and appropriate substitute for small diameter blood vessel replacement is still a challenge to overcome the main drawbacks of autografts and the inadequate performances of synthetic prostheses made of polyethylene terephthalate (PET, Dacron) and expanded polytetrafluoroethylene (ePTFE, Goretex). Therefore, vascular tissue engineering has become a promising approach for small diameter blood vessel regeneration as demonstrated by the increasing interest dedicated to this field. This review is focused on the most relevant and recent studies concerning vascular tissue engineering for small diameter blood vessel applications. Specifically, the present work reviews research on the development of tissue-engineered vascular grafts made of decellularized matrices and natural and/or biodegradable synthetic polymers and their realization without scaffold. 1. Introduction Cardiovascular diseases are the leading cause of death around the world. In 2008, 17.3 million people died from cardiovascular related reasons; specifically 7.3 million were due to coronary heart disease [1]. Currently, in the United States 17% of overall national health expenditures is linked with cardiovascular diseases [2]. Bypass surgeries are commonly performed to allow the peripheral or coronary revascularization. To date, autografts remain the standard clinical approach for the replacement of small diameter blood vessels (inner diameter (ID) < 6？mm). Nevertheless, autografts (such as saphenous vein, arm vein, mammalian artery, or radial artery [3, 4]) show some drawbacks: considerable morbidity associated with autologous harvest and scarce availability due to diseases or previous organ harvesting [4, 5]. Arterial autografts are more indicated for coronary by-pass surgeries due to their higher mechanical properties [6]; internal mammary artery showed a higher patency rate than saphenous vein (85% versus 61%, after 10 years) [7]. Synthetic materials, for example, polyethylene terephthalate (PET) and expanded polytetrafluoroethylene (ePTFE), are successfully used for the replacement of medium-large diameter blood vessels (ID > 6？mm), when high blood flow and low resistance conditions prevail [3, 4, 8]. However, synthetic grafts used for below-the-knee vascular by-pass and coronary by-pass (ID < 6？mm) fail for unacceptable patency rates in the long term. Patency of ePTFE prostheses is 40–50% when used to bypass the proximal popliteal artery at 5 years and 20% when used for infrapopliteal
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