Bifacially Micropatterned Nanofibrous Small-Diameter Vascular Grafts Orchestrate Remodeling to Prevent Thrombosis and Restenosis

Small-diameter vascular grafts (SDVGs) are indispensable devices for clinical revascularization. However, their efficacy is compromised by acute thrombosis and restenosis, which ultimately jeopardize sustained patency. To address this challenge, we developed a bifacially micropatterned nanofibrous SDVG (BMN-SDVG) with distinct topographies tailored for its luminal and abluminal surfaces. The luminal square micropatterns selectively promote rapid endothelial coverage and functional maturation, thereby establishing an antithrombogenic endothelial monolayer. Simultaneously, the abluminal groove micropatterns guide the circumferential alignment and contractile differentiation of smooth muscle cells to prevent restenosis. In an abdominal aorta interposition model, the BMN-SDVG maintained 100% patency with physiological blood flow velocity, demonstrating robust vascular regeneration during the critical early remodeling phase. This spatially orchestrated dual-layer BMN-SDVG offers a clinically translatable solution for sustained SDVG patency.