As
the incidences of cardiovascular diseases have been on the rise
in recent years, the need for small-diameter artificial vascular grafts
is increasing globally. Although
synthetic polymers such as expanded polytetrafluoroethylene or poly(ethylene
terephthalate) have been successfully used for artificial vascular
grafts ≥6 mm in diameter, they fail at smaller diameters (<6
mm) due to thrombus formation and intimal hyperplasia. Thus, development
of vascular grafts for small diameter vessel replacement that are
<6
mm in diameter remains a major clinical challenge. Silk fibroin (SF)
from Bombyx mori silkworm is well-known as an excellent
textile and also has been used as suture material in surgery for more
than 2000 years. Many attempts to develop small-diameter SF vascular
grafts with <6 mm in diameter have been reported. Here, research
and development in small-diameter vascular grafts with SF are reviewed
as follows: (1) the heterogeneous structure of SF fiber (Silk II),
including the packing arrangements and type II β-turn structure
of SF (Silk I*) before spinning; (2) SF modified by transgenic silkworm,
which is more suitable for vascular grafts; (3) preparation of small-diameter
SF vascular grafts; (4) characterization of SF in the hydrated state,
including dynamics of water molecules by nuclear magnetic resonance;
and (5) evaluation of the SF grafts by in vivo implantation
experiment. According to the findings, SF is a promising material
for small-diameter vascular graft development.