Described are tubular silk fibroin compositions and methods for their manufacture and use. Tubular compositions as described herein can be produced in a range of high burst strengths, can easily be made in a range of inner diameters, can be derivatized with functional moieties, and can be produced in a range of permeabilities suitable for particularized uses. In one aspect, the tubular compositions can be used in the repair or replacement of damaged or diseased blood vessels, including, but not limited to vessels smaller than about 6 mm.