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This chapter provides an understanding of the development process leading to advancement of commercially available polymeric expanded polytetrafluorethylene (ePTFE) vascular grafts by the endpoint immobilization of heparin using the CARMEDA® BioActive Surface (CBAS® Surface) technology. The purpose of this endeavor was to improve clinical outcomes for patients undergoing cardiovascular disease treatment and to address the thrombotic failure of vascular grafts. The chapter describes the basic background of ePTFE vascular grafts, the history of early heparin approaches, and the basic science of the CBAS surface leading to prototyping. With initial prototyping success, the product development process through clinical commercialization is explored. Thrombogenicity and intimal hyperplasia appear to be the principal mechanisms of failure when standard ePTFE grafts are used as arterial substitutes in low-flow, high-resistance vascular beds. The application of the CBAS surface was based on the proven usefulness and safety of the technology for increasing the hemocompatibility of blood-contacting surfaces.