In vascular surgery, polymer materials, both natural and synthetic, are widely used for grafting, stenting, and tissue engineering. In this review, we focus on evaluating materials science and engineering, including biocompatibility and clinical outcomes, to aid in biomedical decisions and material selection.
Following the PRISMA guidelines, we searched PubMed, ScienceDirect, Scopus, and the Persian databases Magiran and SID for papers from 2000 to 2024. Inclusion criteria were the use of the specific terms “natural polymers” and “synthetic polymers” alongside “vascular surgery” and “biomechanical properties” and experimental and clinical studies with quantitative biomechanical data. We performed a qualitative assessment of all included studies.
From 2847 articles, 156 studies were selected, which included 89 experimental studies, 45 clinical trials, and 22 reviews. Natural polymers such as collagen and chitosan had better biocompatibility compared to that of synthetic polymers (92.3% vs. 78.1%, p0.001), although they had lower mechanical strength (28.9 ± 6.3 vs. 45.2 ± 8.7 MPa, p0.001). In comparison, synthetic polymers had high tensile strength, with PET at 72.4 ± 12.1 MPa and PU showing 650–800% elongation. Clinically, natural polymers led to better 5-year success rates in natural coronary grafts (85.3% vs. 78.9%), while synthetic polymers outperformed in peripheral grafts (89.2% vs. 76.4% at 3 years). Natural polymers caused decreased inflammatory responses (8.7% vs. 15.2%) but higher rates of complications due to degradation (12.4% vs. 3.8%).
Synthetic polymers had higher mechanical strength, while natural polymers had better soft-tissue integration and biocompatibility. There is additional flexibility in the design with hybrid systems. Further studies of clinical outcomes are needed with smart polymers and uniform methods of testing.
Author Contributions
Conceptualization, E.A. and N.F.; methodology, E.A.; software, E.A.; validation, E.A., N.F.; formal analysis, E.A.; investigation, E.A.; resources, E.A.; data curation, E.A.; writing—original draft preparation, E.A.; writing—review and editing, E.A.; visualization, E.A.; supervision, N.F.; project administration, N.F.; funding acquisition, N.F. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
“Not applicable” for studies not involving humans or animals.
Informed Consent Statement
“Not applicable” for studies not involving humans.
Data Availability Statement
Data are available in this manuscript.
Conflicts of Interest
The authors declare no conflict of interest.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).