Although vascular bypass grafting remains the mainstay for revascularization for ischemic heart disease and peripheral vascular disease, many patients don’t have healthy vessels suitable for harvest. By focusing on the three main contemporary graft types, expanded polyetrafluoroethylene (ePTFE), Dacron and Polyurethane (PU), accumulated clinical and experimental experience of almost half a century was available. However, there is a tendency to develop stenosis in these grafts. The main cause of graft failure is the formation and growth of intimal hyperplasia around the anastomoses. In this paper, we review progress in generating synthetic intimal hyperplasia resistant surfaces by (1) cell seeding for endothelization in graft lumen, (2) anti-thrombosis agent, and (3) anti proliferative agent.