Tissue-engineered blood vessels for clinical translation: Design logic, representative advances and persistent barriers.

Tissue-engineered blood vessels are promising alternatives for small-diameter vascular reconstruction, but clinical translation remains limited by thrombosis, compliance mismatch, delayed endothelialization and unstable host remodeling. This review synthesizes representative advances in scaffold design, seed-cell selection, bioactive regulation and biofabrication, emphasizing how these components interact under hemodynamic load. Rather than cataloguing technologies, we argue that translational success depends on matching material architecture, cellular phenotype, immune remodeling and manufacturing constraints to specific clinical indications. Acellular or host-repopulating grafts may be most realistic for urgent trauma or vascular access, whereas coronary and distal peripheral reconstruction require tighter control of endothelialization and mechanics. Future tissue-engineered vessels should be evaluated as indication-specific products with clinically meaningful benchmarks beyond short-term patency.