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Anastomotic intimal hyperplasia and surface thrombogenicity are the main reasons for the high failure rate of prosthetic small‐diameter vascular grafts. While anastomotic intimal hyperplasia is a multifactorial event, ongoing surface thrombogenicity is primarily caused by the lack of an endothelium, even after years of clinical implantation. After decades of poorly performing synthetic artery‐grafts, tissue engineering has emerged as a promising approach to generate biologically functional bio‐synthetic hybrid grafts mimicking native arteries regarding the presence of an endothelial lining on the blood surface. “In vitro endothelialization” represented the first generation of such tissue‐engineered vascular grafts, utilising cell culture techniques for the creation of a confluent autologous endothelium on ePTFE grafts. The clinical long‐term results with this method in almost 200 patients are highly encouraging, showing …