A living-tissue conduit with strong mechanical properties was used to produce small-diameter vessels. To improve blood compatibility, a shear-resistant confluent monolayer endothelium was formed on the luminal surface of the conduit. Under mechanical stimulation induced by pulsatile flow in a bioreactor, abrupt high-flow shear stress of 15.3 +/- 4.6 dynes/cm(2) was applied to endothelial cells (ECs) seeded onto the lumen of a living-tissue conduit after 2 days of static culture. Scanning electron microscopy images revealed that most of the ECs were washed off after 3 days of dynamic culture. When shear stress was increased stepwise from 1.5 +/- 0.8 to 15.3 +/- 4.6 dynes/cm(2) and applied to the ECs, scanning electron microscopy images of the luminal surface revealed that the confluent monolayer ECs were highly elongated and oriented to the flow direction, similar to findings in natural arteries in vivo. The results indicated that in vitro flow conditions played a key role in determining the durability of the EC layer. Careful design of the bioreactor and careful selection of the culture conditions will greatly improve the chances of producing a useful anti-thrombogenic surface for tissue-engineered small-diameter vessels.