Rapid endothelialization of small-diameter vascular grafts remains a significant challenge in clinical practice. In addition, compliance mismatch causes intimal hyperplasia and finally leads to graft failure. To achieve compliance match and rapid endothelialization, we synthesized low-initial-modulus poly(ester-urethane)urea (PEUU) elastomer and prepared it into electrospun tubular grafts and then functionalized the grafts with poly(ethylene glycol) (PEG) and heparin via covalent grafting. The PEG- and heparin-functionalized PEUU (PEUU@PEG-Hep) graft had comparable mechanical properties with the native blood vessel. In vitro data demonstrated that the grafts are of good cytocompatibility and blood compatibility. Covalent grafting of PEG and heparin significantly promoted the adhesion, spreading, and proliferation of human umbilical vein endothelial cells (HUVECs) and upregulated the expression of vascular endothelial cell-related genes, as well as increased the capability of grafts in preventing platelet deposition. In vivo assessments indicated good biocompatibility of the PEUU@PEG-Hep graft as it did not induce severe immune responses. Replacement of resected carotid artery with the PEUU@PEG-Hep graft in a rabbit model showed that the graft was capable of rapid endothelialization, initiated vascular remodeling, and maintained patency. This study demonstrates the PEUU@PEG-Hep vascular graft with compliance match and efficacious antithrombosis might find opportunities for bioactive blood vessel substitutes.

小直径血管移植物的快速内皮化仍然是临床实践中的重大挑战。此外，顺应性失配会导致内膜增生，并最终导致移植失败。为了实现顺应性匹配和快速内皮化，我们合成了低初始模量的聚（酯-氨基甲酸酯）脲（PEUU）弹性体，并将其制备为电纺管状移植物，然后通过聚乙二醇（PEG）和肝素对移植物进行功能化共价接枝。PEG和肝素功能化的PEUU（PEUU @ PEG-Hep）移植物具有与天然血管相当的机械性能。体外数据表明，移植物具有良好的细胞相容性和血液相容性。PEG和肝素的共价移植显着促进了人脐静脉内皮细胞（HUVEC）的粘附，扩散和增殖，并上调了血管内皮细胞相关基因的表达，并提高了移植物预防血小板沉积的能力。体内评估表明PEUU @ PEG-Hep移植物具有良好的生物相容性，因为它不会诱导严重的免疫反应。在兔模型中用PEUU @ PEG-Hep移植物替代切除的颈动脉表明该移植物能够快速内皮化，启动血管重塑并保持通畅。这项研究表明，具有顺应性匹配和有效抗血栓形成的PEUU @ PEG-Hep血管移植物可能会找到生物活性血管替代物的机会。