Autologous saphenous veins are the most frequently used conduits for coronary and peripheral artery bypass grafting. However, vein graft failure rates of 40–50% within 10 years of the implantation lead to poor long-term outcomes after bypass surgery. Currently, only a few therapeutic approaches for vein graft disease have been successfully translated into clinical practice. Building on the past two decades of advanced understanding of vein graft biology and the pathophysiological mechanisms underlying vein graft disease, nanomedicine-based strategies offer promising opportunities to address this important unmet clinical need. In this Review, we provide deep insight into the latest developments in the rational design and applications of nanoparticles that have the potential to target specific cells during various pathophysiological stages of vein graft disease, including early endothelial dysfunction, intermediate intimal hyperplasia and late-stage accelerated atherosclerosis. Additionally, we underscore the convergence of nanofabricated biomaterials, with a particular focus on hydrogels, external graft support devices and cell-based therapies, alongside bypass surgery to improve local delivery efficiency and therapeutic efficacy. Finally, we provide a specific discussion on the considerations, challenges and novel perspectives for the future clinical translation of nanomedicine for the treatment of vein graft disease.

自体大隐静脉是冠状动脉和外周动脉旁路移植术最常用的导管。然而，植入后 40 年内静脉移植失败率为 50-10%，导致搭桥手术后的长期预后不佳。目前，只有少数静脉移植病的治疗方法成功转化为临床实践。基于过去二十年对静脉移植生物学和静脉移植疾病的病理生理机制的深入理解，基于纳米医学的策略为解决这一重要的未满足临床需求提供了有希望的机会。在这篇综述中，我们深入探讨了纳米颗粒的合理设计和应用的最新进展，这些纳米颗粒有可能在静脉移植疾病的各个病理生理阶段靶向特定细胞，包括早期内皮功能障碍、中间内膜增生和晚期加速动脉粥样硬化。此外，我们强调了纳米制造生物材料的融合，特别关注水凝胶、外部移植支持装置和基于细胞的疗法，以及旁路手术以提高局部递送效率和治疗效果。最后，我们就纳米医学未来临床转化治疗静脉移植疾病的考虑因素、挑战和新视角进行了具体讨论。