Surface-confined polymerization is a bottom-up strategy to create one- and two-dimensional covalent organic nanostructures with a π-conjugated backbone, which are suitable to be employed in real-life electronic devices, due to their high mechanical resistance and electronic charge transport efficiency. This strategy makes it possible to change the properties of the final nanostructures by a careful choice of the monomer architecture (i.e. of its constituent atoms and their spatial arrangement). Several chemical reactions have been proven to form low-dimensional polymers on surfaces, exploiting a variety of precursors in combination with metal (e.g. Cu, Ag, Au) and insulating (e.g. NaCl, CaCO) surfaces. One of the main challenges of such an approach is to obtain nanostructures with long-range order, to boost the conductance performances of these materials. Most of the exploited chemical reactions use irreversible coupling between the monomers and, as a consequence, the resulting structures often suffer from poor order and high defect density. This review focuses on the state-of-the-art surface-confined polymerization reactions, with particular attention paid to reversible coupling pathways and irreversible processes including intermediate states, which are key aspects to control to increase the order of the final nanostructure.