Vascular scaffolds are fundamental devices in treating vascular occlusions, aneurysms, and hemodialysis access. However, their long-term efficacy is often compromised by 2 major pathophysiological responses: acute thrombosis and intimal hyperplasia, underscoring the need for effective antithrombotic treatment and intensive surveillance. This review highlights the emerging approaches used to address such challenges in vascular scaffolds: surface biofunctionalization and intelligent monitoring systems. We first introduce the leading biodegradable elastic polymers for vascular scaffolds, followed by a comprehensive overview of surface biofunctionalization techniques for preventing thrombosis and promoting endothelialization. The review further explores the cutting-edge advances in integrating flexible bioelectronics with cardiovascular implants for intelligent real-time monitoring of hemodynamics, thrombosis, and restenosis. It concludes with a discussion of the remaining challenges and future perspectives, thereby promoting the development of more effective cardiovascular therapies and their clinical applications.