LeMaitre Vascular Q1 2024 Earnings Call Transcript

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Provided by Quartr
May 2, 2024

Key Takeaways

  • Q1 financials delivered 14% sales growth, a 68.6% gross margin and 62% EPS growth, marking the company’s strongest quarterly performance to date.
  • Average selling prices rose 8% in Q1 and, combined with manufacturing productivity improvements and controlled quality costs, drove a 3,300 basis point year-over-year gross margin expansion.
  • The sales organization grew to 137 representatives with a plan to reach 150 by year-end, supporting 44% APAC growth and new offices in Korea, Thailand and Paris alongside double-digit increases in EMEA and the Americas.
  • Regulatory progress includes an expected 14 of 22 MDR CE marks by end of Q3 2024 and full approvals by 2025, with the Autograph CE Mark targeted by Q4 2025 plus submissions in six additional markets.
  • Full-year 2024 guidance was raised to 11% sales growth, a 68.6% gross margin and 33% EPS growth, underpinned by improved operating leverage and a cash balance of $108 million.
AI Generated. May Contain Errors.
Earnings Conference Call
LeMaitre Vascular Q1 2024
00:00 / 00:00

There are 11 speakers on the call.

Operator

Good day, ladies and gentlemen. Welcome to the LeMaitre Vascular First Quarter 2024 Financial Results Conference Call. As a reminder, today's call is being recorded. At this time, I would like to turn the call over to Mr. J.

Operator

J. Pellegrino, Chief Financial Officer of LeMaitre Vascular. Please go ahead, sir.

Speaker 1

Thank you, operator. Good afternoon and thank you for joining us on our Q1 2024 conference call. With me on today's call is our CEO, George LeMaitre and our President, Dave Roberts. Before we begin, I'll read our Safe Harbor statement. Today, we will make some forward looking statements within the meaning of the U.

Speaker 1

S. Private Securities Litigation Reform Act of 1995, the accuracy of which is subject to risks and uncertainties. Wherever possible, we will try to identify those forward looking statements by using words such as believe, expect, anticipate, pursue, forecast and similar expressions. Our forward looking statements are based on our estimates and assumptions as of today, May 2, 2024, and should not be relied upon as representing our estimates or views on any subsequent date. Please refer to the cautionary statement regarding forward looking information and the risk factors in our most recent 10 ks and subsequent SEC filings, including disclosure of the factors that could cause results to differ materially from those expressed or implied.

Speaker 1

During this call, we will discuss non GAAP financial measures, which include organic sales growth as well as operating income, operating expense and EPS excluding special charges. A reconciliation of GAAP to non GAAP measures is discussed in this call, is contained in the associated press release and is available in the Investor Relations section of our website, www.lemait.com. I'll now turn the call over to George LeMaitre.

Speaker 2

Thanks, J. J. Q1 was an excellent quarter with 14% sales growth, a 68.6% gross margin and 62% EPS growth. We posted record sales for each of our 3 geographies and 9 of our 12 product categories. I'll focus my remarks on the top line, our sales force and some regulatory updates.

Speaker 2

Allografts were up 31% in Q1, bovine patches 13% and carotid shunts 27%. APAC was our strongest region, up 44% in Q1 driven by $600,000 of Q1 sales growth from our new sales offices in Korea and Thailand. EMEA sales were up 17%, while the Americas were up 10%. Notably, Canada was up 31% and the UK was up 29%. We ended Q1 with 137 reps, including 62 in North America, 52 in Europe and 23 in APAC.

Speaker 2

We expect to have 150 reps on staff at the end of 2024 with most of the hiring in North America, where our average territory size is $2,200,000 In Europe, the average territory size is $1,100,000 and APAC is $700,000 We also continue to add international sales offices. Last Monday, we had a ribbon cutting ceremony at our new Paris sales office. France is our 6th largest country. Opening this office should improve our connections with French surgeons and hospitals as well as our 8 French sales reps. We've experienced a strong link between opening an office and sales growth.

Speaker 2

A Zurich office might be next. We seem well positioned for the 2027 MDR CE Mark deadline. Based on recent discussions with our notified bodies, we now expect to receive an additional 11 MDR CE marks by September 30. In total, we should possess 14 of our 22 MDR CE marks by the end of the Q3 and we expect to receive the remaining 8 approvals by the end of 2025. Our Autograph CE Mark filing was made in December 2023.

Speaker 2

When we acquired Autograph in 2020, it was cleared for sale only in the U. S. So receiving European approval would be a nice opportunity for our largest U. S. Product line.

Speaker 2

We sold $33,000,000 of Autograph in the U. S. In 2023. We now believe that autograph will receive its CE Mark by Q4 2025. In the meantime, we're also submitting autograph for approval in Canada, Australia, Japan, Korea, Thailand and Singapore.

Speaker 2

Separately, we continue to pursue allograft approvals in Ireland and Germany. We believe that one of these approvals will happen in 2024 and another one in 2025. These are not MDR CE marks, but rather individual approvals by each country's human tissue authority. To conclude, Q1 was an excellent quarter with 14% sales growth, a 68.6% gross margin and 62% EPS growth. We believe our profitability and cash balance provide us strategic optionality.

Speaker 2

With that, I'll turn the call over to JJ.

Speaker 1

Thanks, George. We continue to apply pricing floors to more geographies and more devices. Pricing floors are possible because of our high quality differentiated devices selling into niche markets. Average selling price has increased 8% in Q1 2024, while units increased 3%. This follows our full year 2023 ASP increase of 12% and unit growth of 5%.

Speaker 1

In Q1 2024, we posted a gross margin of 68.6%, up 3,300 basis points year over year. The increase was driven by higher ASPs and productivity improvements. More specifically, a more efficient manufacturing team continues to benefit the P and L. In Chicago, our allograph manufacturing group had a strong Q1 and then Burlington quality costs remain in check. Average selling price increases improved the gross margin by approximately 2.5% in the quarter and our guidance calls for a 68.6 percent gross margin for the full year.

Speaker 1

Operating expenses in Q1 2024 were $24,800,000 an increase of 8% versus the Q1 2023. The increase was driven largely by more employees, including 12 more sales professionals. The 8% increase compares favorably to our 20% adjusted operating expense increase in the full year 2023 and reflects our shift from post COVID rehiring to a more restrained hiring posture in 2024. Q1 2024 operating income increased 51% year over year to $11,900,000 and resulted in an improved operating margin of 22%, up from 17% in the prior year period. EPS was $0.44 in the quarter, up 62%.

Speaker 1

We ended Q1 2024 with $108,000,000 in cash and securities, an increase of $3,200,000 in the quarter. The increase was driven by cash from operations of $5,000,000 Separately, our new ERP system went live in the U. S. In Q1 2024. The system should improve real time reporting, streamline financial processes and provide more sophisticated analytics.

Speaker 1

Implementation at our overseas entities will take place in 2025 and beyond. This project should cost $7,000,000 to $10,000,000 and the annual P and L impact will be about $1,000,000 Regarding guidance, we are forecasting improved operating leverage in 2024 driven by restrained operating expense growth and an improved gross margin. Our updated guidance includes an operating margin of 22% in 2024 versus 19% in 2023 17% in 2022. For more details, please see today's press release, but a few Q2 highlights include sales growth of 10%, gross margin of 68.6% and EPS growth of 31%. And for the full year 2024 guidance has increased to sales growth of 11%, gross margin of 68.6% and EPS growth of 33%.

Speaker 1

With that, I'll turn it back over to the operator for questions.

Operator

Our first question or comment comes from the line of Rick Wise from Stifel. Mr. Wise, your line is open.

Speaker 3

George, maybe I first I guess I must say in fact the proverbial congratulations on another You said you're at 137, still hoping to get to 150 by year end. Is that a stretch target? Are you feeling good? Do you have people lined up? Just maybe talk us through that process.

Speaker 3

You said folks are going you're sort of aiming more in the U. S. Is this territory splitting or you start opening new areas? Just some larger perspective there. Thank you.

Speaker 2

Sure, sure. Thanks for the good question, Rick. Yes, it's been a little bit slow probably inside your question you're pointing that out 136, 136 the last couple of quarters now 137. We have 14 open on the board that have been recruiting for I don't know 1, 3 months on average for those guys. So we definitely feel like we're going to get those people.

Speaker 2

Of course, there's always some turnover. And then probably in the summer, we're also going to be opening up some new expansion territories. And to your point and also from the script, we're definitely hiring in North America almost exclusively. There's 1 or 2 in Europe and 1 or 2 in Asia right now. So no, I think we'll get there.

Speaker 2

It's still we still have 8 months left in the year to get there and hiring is not that hard, it's doable. So feel comfortable where we are and as for how we're getting these. I think to stylize, I think we're largely splitting the territories that are already out there. We called out this $2,200,000 average size. We have a sort of rule of thumb inside of LeMaitre that once something gets that big, you probably should split it in half.

Speaker 2

And on average, all of our territories in the U. S. Are at that size now.

Speaker 3

Got you. J. J, a question for you on gross margin. Thanks for the detailed color and the breakdown On the price contribution, maybe talk to us about the productivity side. Is this just is it volume?

Speaker 3

Is it mix? Or is there something happening that should drive in addition to price and volume expanding gross margins maybe longer than we're appreciating?

Speaker 1

Yes, I would say it's sort of 3 things, average price increases, the DL efficiencies and quality costs. And I would expect those to continue as we go through the year.

Speaker 2

Yes. And so Rick, part of this story here is that the quality, if you look back over the last 4 years, it feels like there's a pretty simple story in gross margin where quality costs have gone have added about 4 or 5 points of cost just on our gross margins over the last 4 or 5 years. And we feel like we've kind of put a top or a head on that and it feels like we've got that in control and it's not going to get worse.

Speaker 1

Yes. And in terms of the price increases, Rick, I would say, those are probably adding 2%, 2.5% to the gross margin. So if we get an 8% or 9% price hike in a year, it's probably adding something like that. So a really nice tailwind. And then the direct labor efficiencies piece, that's the story of hiring manufacturing folks post COVID.

Speaker 1

And then that process was kind of difficult and sloppy. And so we had trouble getting people in the door and we had trouble keeping people, turnover was a little bit higher and then we had trouble training folks. And so as we got through that, those manufacturing efficiencies, I. E. The direct labor folks being in their sort of stations longer, more utilization, if you will, and then being more efficient, making devices quicker, if you will.

Speaker 1

That all started to come through to the P and L. And I think we're seeing that those sort of 3 favorable trends happening through the rest of the year as well.

Speaker 3

Got you. And maybe just a last one for me for now. I mean, there's so much to choose from here, but I'm really struck by the incredibly impressive OUS growth performance. And again, my theme here is just the sustainability of the kind of impressive growth you're turning in, 44% in Asia Pacific, etcetera, opening new offices in France, the new product approvals and rollouts. Talk to us about the sustainability of the kind of growth we're seeing.

Speaker 3

And I mean, is there upside from here? Just any incremental perspective there George would be welcome.

Speaker 2

Sure. Thanks for a great question, Rick. And I appreciate how you frame that. I think particularly at Asia Pac, what you're seeing over here in the last 5 years is a repeat of what we did in Europe back in the I'm going to call it the odds and the tens. I don't even know what you're supposed to call those anymore.

Speaker 2

But I think right now you're sort of shifting your focus a little bit over there. And to simplify this for everyone on the call, I think this is just a virgin territory hypothesis and we just keep finding new places to go. Korea is going crazy right now in a good way for us. Thailand, we hope we'll start with that as well. And I even think something we didn't mention here today was China actually.

Speaker 2

We started not using the word China on these calls because things have been so delayed with the regulatory. But operationally and organically, it's going crazy. It's going great. We had a 92% quarter in Q1 in China. So I would say simply put, it's virgin territory for Asia.

Speaker 2

And then I think when you flip your eyes back over to Europe, it's about getting these approvals for RFA and Artigraft, a really big product lines for us in the U. S. The number one product line is Artigraft and then RFA is not that far behind or Allograft sorry, these two words are very close. Artigraft and Allograft are the 2 biggies in the U. S.

Speaker 2

And we don't have any approvals for those 2 products in Europe. So I think the sustainability may not even be next year for both those products, it may be the year after. But I think you got a nice runway of bringing American devices overseas.

Speaker 3

Thanks so

Speaker 2

much. Thanks, Rick.

Operator

Thank you. Our next question or comment comes from the line of Suraj Kalia from Oppenheimer. Sir, your line is open.

Speaker 4

Good afternoon, everyone. George, can you hear me all right?

Speaker 2

I can, Suraj.

Speaker 4

Perfect. So gentlemen, congrats on a nice quarter. George, forgive me shuttling between many calls. Did you all talk about valvulotome growth? Just wanted to get a sense where we are at least on a macro level for valvulotomes given the intense debate on endovascular versus surgical?

Speaker 2

Of course, of course. We didn't bring it up. Valvulotomes were up 2% in Q1. Last year was a much bigger growth number. Maybe if I could say, this is so typical, but we had a really tough comp in Q1 to beat up on for Valvatomes, but they were still up 2%.

Speaker 2

If you look out over the year and the annualization of everything, units and stuff, I feel like it's a last year was a nice year for valvulotomes. This year is not quite as nice, but there still should be a little bit of growth with valvulotomes.

Speaker 4

Got it. Fair enough. The other thing George, in terms of price impact in the quarter end, how should we think about average sales rep tenure versus a year ago?

Speaker 2

Interesting. We hadn't really discussed that much in the prep for this meeting. It feels to me like sales force turnover has not been a problem for us over the last, I don't know, 18 months ago or so, 24 months. So it's not something we're on that much right now. I would say unchanged versus a year ago sales force turnover.

Speaker 4

Got it. And George, one final question. Obviously, there's been a large strategic that has just surprised everyone with takeout multiples. And you guys have been relatively very disciplined on M and A and basically showcasing to the street in terms of your strategy. And David has been very articulate on that.

Speaker 4

George, I'm curious if you could just shed some light on how you see the potential target landscape, just the M and A environment, how you all are seeing it? What should we think about as the year progresses? Thank you for taking my question.

Speaker 5

Hey, Suraj. It's Dave. If you don't mind, I'll jump in. You mentioned the multiples you're probably referring to J and J, Shockwave and the roughly 18 times 2023 revenue. That was obviously a huge announcement in our space.

Speaker 5

I would say, we're always cognizant of valuation. That was a very high valuation. There's another lower one, Advanced Medical Solutions bought a division of bought Peter's Surgical in Europe for less than 2 times sales. So valuation always depends on what you're buying. Of course, I think I read your reports and I see small cap medtech valued around 4 to 5 times sales.

Speaker 5

So I mean, we are I'd say we are very we do focus on value a lot. I'd say more than that, we focus on strategic fit. And so for us finding the right target, which ideally is an open vascular targets, they're about 25 of them with more than $5,000,000 of revenue. That's where we're really hunting. And in terms of this year, you never know where I'd say we've got 2 targets or a little bit larger that we're talking to, but things come and go.

Speaker 5

So but we're always hunting. So I guess I'll leave it with that unless you have a follow-up.

Speaker 4

That should be good enough. Gentlemen, thank you for taking my question and congrats again.

Speaker 2

Thanks a lot, Suraj.

Operator

Thank you. Our next question or comment comes from the line of Daniel Strauder from Citizens JMP. Mr. Strauder, your line is now open.

Speaker 6

Yes, great. Thanks. So, just had a quick question on the operating margin profitability in 2024. And correct me if my math is wrong, but if we look at gross margin and revenue guide for 2Q in the year due to that operating income number, it seems like there's a good amount more of OpEx leverage than we were anticipating. So I guess, if that is the case, where is this primarily coming from on the income statement?

Speaker 6

Is it mainly from sales rep utilization? And how are you continuing to drive this throughout the year? Thanks.

Speaker 2

I feel like at a really high level the leverage that we're going to get this year is about the extra sales growth versus what we were expecting. You see the guide here has changed I think from 2.12 the last time we spoke to you guys in February and here we are now at $2.15 for the whole year. And then buried inside of that as we've lost some to the dollar, the strengthening of the dollar. So I think that's a little bit mostly where the leverage is coming from in the P and L. And then also the gross margin, we were coming at you last time with a 68 percent gross margin.

Speaker 2

We're starting to feel a little bit more comfortable about our gross margin. And so we're giving you the 68.6% now for the year instead of 68.0 percent. As we were preparing our guidance and everything, we kept off expenses exactly the same.

Speaker 1

And Danny, I would say on the gross margin piece, we beat a little bit in Q1 by 10 basis points or so. And FX is actually hurting us by about 0.2%, 0.3% since our last guide for the rest of the year. So the 0.6% increase that you're getting on gross margin is actually closer to 1% maybe or so. And part of that I think is because when we did guidance last time, we thought ASPs were going to be in the 6% or 7% range, maybe they're more like the 8% or 9% range. And so there's nice tailwinds there.

Speaker 1

And then those pieces we were talking about earlier in terms of direct labor efficiencies and quality costs and all that helping us as well in the second half.

Speaker 2

Hope that gets to your question, Daniel.

Speaker 6

Yes, that was great. And then just one follow-up, more along the lines of the revenue guidance and cadence in the back half. Typically 3Q steps down from 2Q. Are you still expecting that normal seasonality? Or could that be a little more modest from what you're seeing given the strength thus far and what you've guided to?

Speaker 6

And I know you have some pretty tough comps in 3Q and 4Q, so I just want to get your thoughts on your confidence in second half sales growth as you sit here today?

Speaker 1

Yes. So when we do guidance, we sit in the room for 2 days basically going through all this stuff on each of the lines and sales is obviously the number one driver. And so I would say we look at that from a lot of different angles. Seasonality is certainly one of those and Q3 is generally sort of the weaker quarter of the 4 quarters, particularly in Europe as folks go on vacation and go to the mountains and the beach and all that kind of good stuff. So I would say, yes, you would expect that cadence where Q2 would be higher, Q3 would go down and then Q4 would come up and maybe feel a little bit more like Q2 ish sort of thing.

Speaker 1

If you do that by day, you wind up getting some pretty sales per day, you get some pretty logical answers there. And if you look at it percentage wise through the quarters, I think you get some good answers there. There is an FX topic that's hurting us as we go through the rest of the year and certainly since last guide, I think it was like $1,100,000 or so that FX has gone against us. So our increase in guide is actually maybe a little bit more robust than it seems. We've beat by what, dollars 1,700,000,000 1,800,000 in Q1 and now we're given an extra up to $3,000,000 and then really it's up to $4,000,000 $4,200,000 because of that FX piece.

Speaker 1

So I think we're signaling that we feel more confident about the sales answer driven by ASPs and hospital cases and some of the good results in these individual product lines as well as the geographies that we talked about Thailand and Korea and other places that are sort of popping up and doing well also.

Speaker 6

That's great. Thank you for the questions and congrats on a great quarter.

Operator

Thanks, Daniel. Thank you. Our next question or comment comes from the line of Michael Sarcone from Jefferies. Mr. Sarcone, your line is now open.

Speaker 7

Hi, good afternoon and thanks for taking my questions. Thanks, Mike.

Speaker 8

Thanks, Mike. Thanks,

Speaker 7

Mike. The ASPs that you're getting 8%. I think JJ said, this year now you're expecting closer to 8% to 9%, really impressive. Just wanted to get a feel for how sustainable you think that level of price taking is as we look beyond 2024?

Speaker 2

Right. So Michael, I try to make a real point of not guiding past Q4 of 2024 here. But in sort of answer to your question as much as I can, I feel like we're in about the 6th inning in a 9 inning baseball game? People have been asking this question a lot and we've come back to that. We're in the 6th inning of these price hikes.

Speaker 7

All right, great. That's helpful. Thank you.

Speaker 9

And then just a question around

Speaker 7

the ERP system you've talked about. You mentioned real time reporting, financial processes and more sophisticated analytics.

Speaker 9

I was wondering if

Speaker 7

you could speak to does this help at all, boost sales force productivity in any way? And then on the expense side, are you going to be able to bring any expense efficiencies from some of the analytics you may be getting from the ERP system?

Speaker 2

So it's a great question. And it's a big project in Burlington even though it doesn't really poke out too much on calls like this. We have this very strong belief that better accounting leads to better decisions everywhere in your business. So the answer to all of your questions is yes, we probably can watch the sales folks more closely and yes, we can bring some efficiencies out of the operations. We've never installed a program this big.

Speaker 2

We were still on sort of what I'll call a junior varsity platform until February of this year. So this is a big switch for us. We're really excited about it. We all feel strongly that better accounting will lead to better decisions and better results for the company.

Speaker 1

Mike, as an example, our analytics tool is homegrown and the analytics tool is homegrown by our IT folks who did a phenomenal job and it does a really nice job of getting data to folks quickly and slicing and dicing. But there's an even better answer out there that Microsoft has been working on for the last 20 years. And so eventually we'll replace that analytics tool and it will pump out even more sophisticated data and make it easier to get just one example of how it might benefit us in the future.

Speaker 7

That's helpful, JJ. Thanks. Yes, I was going to say it's impressive. There's no shortage of companies that have sales force or commercial disruptions, while they're implementing large ERP systems. But just one last one for me that I'll squeeze in.

Speaker 7

Could you just give us an update on how things are going with Zio and how you're thinking there?

Speaker 5

Hey, Mike, it's Dave Roberts. Sure, happy to. In Q1, we did about $1,250,000 sales of Zio, which was right at the guidance, but sort of performed where we expected. That was down from the $1,500,000 in Q4. And we don't really guide on the product line going forward, but it had a good April, so we'll see where it comes out.

Speaker 5

But I would say at a high level, it's a little bit under what we expected when we signed the deal a year ago, but not too far under. And Q1 was the Q1 where Azeal was on the LeMaitreps commission plan. So it's still sort of early days at the moment.

Speaker 7

Got it. Thank you.

Speaker 2

Thanks a lot for your questions.

Operator

Thank you. Our next question or comment comes from the line of James Sidoti from Sidoti and Company. Mr. Sidoti, your line is now open.

Speaker 8

Thank you. This is Alex on for Jim. Congrats on the quarter and thanks for taking questions. Couple of quick ones for me. We spoke about GLPs and the effect on cardiovascular event reductions in the fall.

Speaker 8

It sounded like there wasn't a meaningful effect. I just wanted to check-in on that and see if that still helped.

Speaker 2

Yes. Okay. Hey, thanks for your question, Alex. It's George. We have not seen anything in the whole sort of thing kind of came and went as a sort of from our perspective sort of as a Wall Street brouhaha.

Speaker 2

We feel comfortable that our business proceeds with or without GLP. So no effect up here.

Speaker 8

Thanks for the update. Appreciate it. And I wanted to check-in on the manufacturing operations. I think you guys had spoken about thinking of adding an additional shifts or opening up another facility maybe in Burlington. Just wanted to check-in on how you're thinking about that these days?

Speaker 2

Hi, Alex. Yes. Okay. So look, it's a bit of an old topic in some ways, which is we did this project called Small Ball about a year and a half ago. And instead of renting a new building, what we did is we went into one of our buildings, we carved out another 50% of cleanroom space.

Speaker 2

And that's online maybe about 12 months ago or so. And then we went and hired a lot of people for that and we also hired a second shift. I would say in a hopeful analysis, the better gross margin here is a little bit impacted by all that, but not exactly. So yes, we have a much bigger floor plate for manufacturing and we also have 2nd shift now. There's really no constraints to manufacturing up here.

Speaker 2

I switch the topic a little bit. You didn't ask about this, but maybe we talk about it a little bit. But in Chicago where we process our allograft, we felt a little production constrained out there and we've been adding bodies and resources out there recently and we seem to be turning the corner on some production issues out there. So we're excited about that. It might lead to more allograft growth going forward, But we shall see and we don't really guide by product line.

Speaker 8

Thank you. Yes, I appreciate the clarification there. A lot of good questions today and that's all from us. Thank you.

Speaker 2

Thanks a lot, Alex.

Operator

Thank you. Our next question or comment comes from the line of Brooks O'Neil from Lake Street Capital Markets. Mr. O'Neil, your line is now open.

Speaker 10

This is Aaron on the line for Brooks. Congrats on the great quarter. Did you mention what percentage of the Q4 sales growth was related to price versus volume, more specifically, how that was sort of split? And then maybe just in addition to that, any thoughts around changes within this split moving forward throughout the year if you have that info?

Speaker 2

Yes. And you want Q1 or Q4?

Speaker 10

Sorry, Q1.

Speaker 2

Okay. Yes. Q1, 8% price, 3% units. And we're trying not to guide for the whole year. We don't quite know, but maybe that's the answer about we're in the thickening of price hikes, maybe we still have some to go with that.

Speaker 1

And if you want a little more color on that, the higher the heavier hitters in terms of ASP increases this quarter were autograft and ReStoreFlow and some of our catheters and OmniFlow. And if you thought about it last year, it was more of valvulotomes and shunts. It was more of a broad based ASP increase this year in Q1 anyway. We'll see what happens as we go forward.

Speaker 10

Okay, got you. That's helpful. And then back to the sales reps, you mentioned you plan to hire a few more this year. I'm assuming that the reps that you have hired in the past and getting them properly trained has been a bit challenging and maybe time consuming. How have you sort of approached this?

Speaker 10

And would you say that you're starting to see some tangible benefits in that aspect?

Speaker 2

You mean in terms of I would say, I generally feel like we haven't changed that much in how we train them over the years. So there has been no gap between old reps hired and new reps hired. You're right to point out though, Ed, that it is a time consuming project. I would say we have never been the number one trainer for medical device companies in the United States to sort of get at this right now. We actually have a job requisition open and being filled for a sales trainer, a dedicated sales trainer.

Speaker 2

And that will be the first one that we've had and it feels like 5 or 9 years here. So there's some hope that we can sort of close down on that gap or that area of opportunity at the company.

Speaker 10

Got you. Appreciate that color. And again, congrats on the quarter guys.

Speaker 2

Thanks a lot, Ed.

Operator

Thank you. Our next question or comment comes from the line of Brett Fishman from KeyBanc. Mr. Fishman, your line is now open.

Speaker 9

Hey guys, thanks very much for taking the questions. Follow-up on Artigraft, it's been a very successful acquisition just considering the U. S. Performance. You mentioned a bunch of potential new markets and understand it's still very early in that process.

Speaker 9

But curious how you're looking at that opportunity from a TAM perspective across the markets that you're looking to launch in. Maybe just understand it's still like more than a year out, but maybe like a directional range of outcomes if those launches are in fact successful?

Speaker 2

Yes. Brett, that's a fantastic question. We think about this and we talk about this a lot. Maybe if I limit my comments to Europe, it's easier. Europe being sort of 50% of the rest of world besides the U.

Speaker 2

S. And Canada. You'd love to say, oh, it's exactly Europe is half the I'd say it's half the size of the U. S. You'd love it financially.

Speaker 2

Let's say, oh, it's half of that. But then I'd cut that in half again for one reason, which is in Europe, they don't use as much PTFE and prosthetic implants in AV access cases as we do in the United States. It's a little bit of a different practice pattern by the vascular surgeons over there. So if you took our 33 of revenue in the U. S, let's say that's kind of full level, we still plan on growing that.

Speaker 2

But let's take 33 in the U. S, you go to 16 and then cut it in half, 16 being geographically financially Europe is always about half as big as the U. S. And they cut that in half again. So maybe there's an 8 TAM there and then maybe if you want to be really high level, you could say there's another 8 TAM away from that in places like Japan and Korea and China.

Speaker 9

All right. Super helpful color. I appreciate that. And then one follow-up on the product area. Another good quarter for Alligraft, not too surprising, but the trends in carotid shunts looks like they bumped up again this quarter, I think, to 27%.

Speaker 9

Just curious maybe on what was underlying that level of growth and how sustainable that might be?

Speaker 2

Right. I mean, it's just a fantastic story that's going on with Shunt, which is the main competitor or one of the 2 main competitors barred left the market because they were frustrated with Brussels and the whole new CEMDR thing. And so they just said, we're not going to support this product line. So we're just taking all the old units from those guys. In addition, since the CE barriers have gotten higher and higher, we're taking the opportunity to put in some price changes on that product line.

Speaker 2

So you got more units because Bard left and then because Bard has gone away and there's no new competitors coming in, you probably have better pricing. So I think the number was something like 17% this year this quarter Q1. What was

Speaker 5

27%.

Speaker 2

Sorry, 27% was our up, Brett, in that. So excellent activity going on there. Despite TCAR, despite stenting and all that, it's been a fantastic run.

Speaker 9

I appreciate taking the questions and congrats on the quarter guys.

Speaker 2

Thanks a lot, Brett.

Operator

Thank you. I'm showing no additional questions in the queue at this time. Ladies and gentlemen, that concludes today's conference. I would like to thank you for your participation and you may now disconnect. Have

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