LeMaitre Vascular - Q1 2024
May 2, 2024
Transcript
Operator (participant)
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.J. Pellegrino, Chief Financial Officer of LeMaitre Vascular. Please go ahead, sir.
J.J. Pellegrino (CFO)
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.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 2nd, 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-K and subsequent SEC filings, including disclosure of the factors that could cause results to differ materially from those expressed or implied. 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.lemaitre.com. I'll now turn the call over to George LeMaitre.
George LeMaitre (CEO)
Thanks, JJ. 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 three geographies and nine of our 12 product categories. I'll focus my remarks on the top line, our sales force, and some regulatory updates. 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 U.K. was up 29%. We ended Q1 with 137 reps, including 62 in North America, 52 in Europe, and 23 in APAC.
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 $2.2 million. In Europe, the average territory size is $1.1 million, 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 sixth largest country. Opening this office should improve our connections with French surgeons and hospitals, as well as our eight French sales reps. We've experienced a strong link between opening an office and sales growth. 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 third quarter, and we expect to receive the remaining eight approvals by the end of 2025. Our Artegraft CE mark filing was made in December 2023. When we acquired Artegraft 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. We sold $33 million of Artegraft in the U.S. in 2023. We now believe that Artegraft will receive its CE mark by Q4 2025. In the meantime, we're also submitting Artegraft for approval in Canada, Australia, Japan, Korea, Thailand, and Singapore.
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. With that, I'll turn the call over to JJ.
J.J. Pellegrino (CFO)
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%. 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 PNL. In Chicago, our Allograft manufacturing group had a strong Q1, and in 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% gross margin for the full year. Operating expenses in Q1 2024 were $24.8 million, 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 $11.9 million, 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%.
We ended Q1 2024 with $108 million in cash and securities, an increase of $3.2 million in the quarter. The increase was driven by cash from operations of $5 million. 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. Implementation at our overseas entities will take place in 2025 and beyond.
This project should cost $7 million-$10 million, and the annual P&L impact will be about $1 million. 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, and 17% in 2022. For more details, please see today's press release, but Q2 highlights include: sales growth of 10%, gross margin of 68.6%, and EPS growth of 31%. For the full year, 2024 guidance has increased to sales growth of 11%, gross margin of 68.6%, and EPS growth of 33%. With that, I'll turn it back over to the operator for questions.
Operator (participant)
Ladies and gentlemen, if you have a question or comment at this time, please press star one one on your telephone keypad. If your question has been answered or you wish to remove yourself from the queue, simply press star one one again. Once again, if you have a question or comment, please press star one one on your telephone keypad. Please stand by while we compile the Q&A roster. Our first question or comment comes from the line of Rick Wise from Stifel. Mr. Wise, your line is open.
Rick Wise (Equity Research Analyst)
George, maybe I first, I guess I must say, in fact, the proverbial congratulations on another excellent quarter, and thank you. To start off with the questions, let's focus on the sales force. 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. 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.
George LeMaitre (CEO)
Sure, sure. Thanks for the good question, Rick. Yeah, 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, one, three months on average for those guys. So we definitely feel like we're gonna get those people. Of course, there's always some turnover, and then probably in the summer, we're also gonna 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 one or two in Europe and one or two in Asia right now. So no, I think we'll get there.
You know, it's still, we still have eight months left in the year to get there, and, you know, 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 $2.2 million 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, and on average, all of our, all of our territories in the U.S. are at that size now.
Rick Wise (Equity Research Analyst)
Gotcha. JJ, 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? Is it mix? Is there something happening that should drive in addition to price and volume expanding gross margins, maybe longer than we're appreciating?
J.J. Pellegrino (CFO)
Yeah, I would say it's sort of three things with average price increases, the DL efficiencies, and quality costs, and I would expect those to continue as we go through the year.
George LeMaitre (CEO)
Yep. And so Rick, part of this story here is that the quality, if you look back over the last four 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 four or five 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 a-- it's not going to get worse.
J.J. Pellegrino (CFO)
Yeah, 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. 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, that all started to come through to the P&L, and I think we're seeing that, those sort of three favorable trends happening through the rest of the year as well.
Rick Wise (Equity Research Analyst)
Gotcha. And maybe just a last one from 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, et cetera, 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, and I mean, I mean, is there upside from here? Just any incremental perspective, there, George, would be welcome.
George LeMaitre (CEO)
Sure. Thanks for the great question, Rick. And appreciate how you framed that. I think particularly the Asia Pac, what you're seeing over here in the last five years is a repeat of what we did in Europe back in the, I'm going to call it the aughts and the tens. I don't even know what you're supposed to call those anymore, 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's going crazy right now in a good way for us. Thailand, we hope will start with that as well. And I even think something we didn't mention here today was China, actually.
You know, we, we started not using the word China on these calls because things have been so delayed with the, 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. And then I think when you flip your eyes back over to Europe, it's about getting these approvals for RFA and Artegraft, really big product lines for us in the U.S.
The number one product line is Artegraft, and then RFA is not that far behind. Or Allograft, sorry. These two words are very close. Artegraft and Allograft are the two biggies in the U.S., and we don't have any approvals for those two products in Europe. So, I think the sustainability, it 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.
Rick Wise (Equity Research Analyst)
Thanks so much.
George LeMaitre (CEO)
Thanks, Rick.
Operator (participant)
Thank you. Again, ladies and gentlemen, if you have a question or comment at this time, please press star one, one on your telephone keypad. Our next question or comment comes from the line of Suraj Kalia from Oppenheimer. Sir, your line is open.
Suraj Kalia (Equity Research Analyst)
Good afternoon, everyone. George, can you hear me all right?
George LeMaitre (CEO)
I can, Suraj.
Suraj Kalia (Equity Research Analyst)
Perfect. So gentlemen, congrats on a nice quarter. George, forgive me, shuttling between many calls. Did you all talk about valvulotome growth? You know, 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.
George LeMaitre (CEO)
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 valvulotomes, but they were still up 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 still should be a little bit of growth with valvulotomes.
Suraj Kalia (Equity Research Analyst)
Got it. Fair enough. The other thing, George, in terms of price impact on the quarter, and how should we think about average sales rep tenure versus a year ago?
George LeMaitre (CEO)
Hmm, 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.
Suraj Kalia (Equity Research Analyst)
Got it. And George, one final question. Obviously, there's been a large strategic that has, you know, just surprised everyone with takeout multiples. And you guys have been relatively very disciplined on M&A and, you know, basically showcasing to the street in terms of your strategy. And David has, you know, been very articulate in that. George, I'm curious if you could just shed some light on how you see the potential target landscape, just the M&A environment, how y'all are seeing it, what should we think about as the year progresses? Thank you for taking my question.
Dave Roberts (President)
Hey, Suraj, it's Dave. If you don't mind, I'll jump in. You know, you mentioned the multiples, you're probably referring to J&J Shockwave and the roughly 18x 2023 revenue. That was obviously a huge announcement in our space. I would say, you know, we, 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 Peters Surgical in Europe for less than 2x sales. So, you know, valuation always depends on what you're buying. Of course, I think I, I read your reports, and I see small cap med tech valued around 4x-5x sales. So, I mean, we are. I'd say we are very. We, we, we do focus on valuation a lot. I'd say more than that, we focus on strategic fit.
And so for us, finding the right target, which, you know, ideally, is an open vascular target. There are about 25 of them, with more than $5 million of revenue. That's where we're really hunting. And in terms of, you know, this year, you never know where. I'd say, we've got two targets that are a little bit larger that we're talking to, but, you know, things come and go, so, but we're always hunting. So I guess I'll leave it with that unless you have a follow-up.
Suraj Kalia (Equity Research Analyst)
Nope, that should be good enough. Gentlemen, thank you for taking my question, and congrats again.
George LeMaitre (CEO)
Thanks a lot, Suraj.
Operator (participant)
Thank you. Our next question or comment comes from the line of Daniel Stauder from Citizens JMP. Mr. Stauder, your line is now open.
Daniel Stauder (Equity Research Analyst)
Yeah, great, thanks. So, just a quick question on, you know, the operating margin profitability in 2024, and correct me if my math is wrong, but if we look at, you know, the gross margin and revenue guide for 2Q in the year to, to that operating income number, it seems like there's a good amount more of OpEx leverage than we were anticipating. So I guess, you know, if that is the case, where is this primarily coming from on the income statement? You know, is it mainly from sales rep utilization, and how are you continuing to drive this throughout the year? Thanks.
George LeMaitre (CEO)
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 $212 the last time we spoke to you guys in February, and here we are now at $215 for the whole year. And then buried inside of that is we've lost some to the, you know, 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&L. And then also, the, you know, gross margin, we're coming at you last time with a 68% gross margin. 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 the 68.0%. As we were preparing our guidance and everything, we kept OpEx expenses exactly the same.
J.J. Pellegrino (CFO)
And Daniel, I would say on the gross margin piece, you know, we, 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%-7% range. Maybe they're more like the 8%-9% range, and so there's nice tailwinds there. And then those pieces we were talking about earlier in terms of direct labor efficiencies and quality costs and all that, helping us as, as well in the second half.
George LeMaitre (CEO)
Hope that gets to your question, Daniel.
Daniel Stauder (Equity Research Analyst)
Yeah, that was great. Then, just one follow-up, more along the lines of the revenue guidance and cadence in the back half. You know, typically 3Q steps down from 2Q. Are you still expecting that normal seasonality, or could that be a little more modest from what you are seeing given the strength, you know, thus far and what you've guided to? And I know you have some pretty tough comps in 3Q and 4Q, so just wanted to get your thoughts on, you know, your confidence in second half sales growth as you sit here today.
J.J. Pellegrino (CFO)
Yeah. So, you know, when we do guidance, we sit in the room for two days, basically, going through all this stuff on each of the lines, and sales is obviously the number one driver. 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 four 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, yeah, 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.
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 $1.1 million or so, that FX has gone against us. So our increase in guide is actually, you know, maybe a little bit more robust than it seems. We've been beat by, what, $1.7 million, $1.8 million in Q1, and now we're given an extra, you know, up to $3 million, and then really it's up to $4 million, $4.2 million because of that FX piece.
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 talk about, Thailand and Korea and other places that are sort of popping up and doing well also.
Daniel Stauder (Equity Research Analyst)
That's great. Thank you for the questions, and congrats on the great quarter.
George LeMaitre (CEO)
Thanks, Daniel.
Operator (participant)
Thank you. Our next question or comment comes from the line of Michael Sarcone from Jefferies. Mr. Sarcone, your line is now open.
Michael Sarcone (Equity Research Analyst)
Hi, good afternoon, and thanks for taking my question. Just like Art, you know, the ASPs that you're getting 8%, I think J.J. said, you know, this year now you're expecting closer to 8%-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.
George LeMaitre (CEO)
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 sixth inning in a nine-inning baseball game. People have been asking this question a lot, and we've come back to that. We're in the sixth inning of these price hikes.
Michael Sarcone (Equity Research Analyst)
All right, great. That's helpful. Thank you. And then just a question around the ERP system you talked about. You mentioned real-time reporting, financial processes, and more sophisticated analytics. Was wondering if you could speak to, you know, does this help at all, boost sales force productivity in any way? And then, you know, on the expense side, you know, are you going to be able to wring any expense efficiencies from some of the analytics you may be getting from the ERP system?
George LeMaitre (CEO)
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. You know, 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 wring some efficiencies out of the operations. You know, we've never installed a program this big. 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.
J.J. Pellegrino (CFO)
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'll pump out even more sophisticated data and make it easier to get just one example of how it might benefit us in the future.
Michael Sarcone (Equity Research Analyst)
That's helpful, JJ. Thanks. Yeah, I was gonna say it's impressive, you know, there's no shortage of companies that have sales force or commercial disruptions while they're implementing, you know, large ERP systems. But just one last one for me that I, I'll squeeze in. Could you just give us an update on how things are going with Aziyo and how you're thinking there?
Dave Roberts (President)
Hey, Mike, it's Dave Roberts. Sure, happy to. In Q1, we did about $1.25 million sales of Aziyo, which was right at the guidance, so sort of performed where we expected. That was down from the $1.5 million in Q4. And, we don't really guide on the product line going forward, but, it had a good, it had a good April, so we'll see where it comes out. 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 first quarter where Aziyo was on the LeMaitre reps' commission plan, so it's still sort of early days at the moment.
Michael Sarcone (Equity Research Analyst)
Got it. Thank you.
George LeMaitre (CEO)
Thanks a lot for your questions.
Operator (participant)
Thank you. Our next question or comment comes from the line of James Sidoti from Sidoti & Company. Mr. Sidoti, your line is now open.
Alex Hammond (Senior Equity Research Analyst)
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, you know, and the effect on cardiovascular event reductions in the fall. Sounded like there wasn't a meaningful effect. I just wanted to check in on that and see if that still held.
George LeMaitre (CEO)
Yeah. Okay. Hey, thanks for your question, Alex. It's George. We have not seen anything, and the whole sort of thing kind of came and went as... So from our perspective, sort of as a Wall Street brouhaha, we feel comfortable that our business proceeds with or without GLP, so no effect up here.
Alex Hammond (Senior Equity Research Analyst)
Thanks for the update. Appreciate it. I wanted to check in on the manufacturing operations. You guys, you know, had spoken about thinking of, you know, adding an additional shift or opening up another facility, maybe in Burlington. Just wanted to check in on how you're thinking about that these days.
George LeMaitre (CEO)
Hi, Alex. Yeah. 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, and we carved out another 50% of clean room space, 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, you know, 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 second shift now. There's really no constraints to manufacturing up here. I switched the topic a little bit.
You didn't ask about this, but maybe we talked about 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. That might lead to more allograft growth going forward, but we shall see, and we don't really guide by product line, so.
Alex Hammond (Senior Equity Research Analyst)
Thank you. Yeah, I appreciate the clarification there. A lot of good questions today, and that's all from us. Thank you.
George LeMaitre (CEO)
Thanks a lot, Alex.
Operator (participant)
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.
Aaron Wukmir (Healthcare Equity Research Associate)
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, versus volume? More specifically, you know, 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?
George LeMaitre (CEO)
Yeah, and you want Q1 or Q4?
Aaron Wukmir (Healthcare Equity Research Associate)
Sorry, Q1.
George LeMaitre (CEO)
Okay, yeah. Q1, 8% price, 3% units. We're trying not to guide for the whole year. We don't quite know, I—but maybe that's the answer about we're in the sixth inning of price hikes. Maybe we still have some to go with that.
J.J. Pellegrino (CFO)
If you want a little more color on that, the heavier hitters in terms of ASP increases this quarter were Artegraft and RestoreFlow and some of our catheters and Omniflow. If you thought about it last year, it was more of valvulotomes than shunts. It was more of a broad-based ASP increase this year, in Q1 anyway. We'll see what happens as we go forward.
Aaron Wukmir (Healthcare Equity Research Associate)
Okay, gotcha. That's helpful. And then back to the sales reps. You know, you mentioned you plan to hire a few more this year. You know, 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, and would you say that you're starting to see some tangible benefits in that aspect?
George LeMaitre (CEO)
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 hasn't—there's 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, and that'll be the first one we've had in, it feels like five or nine 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.
Aaron Wukmir (Healthcare Equity Research Associate)
Gotcha. Appreciate that color, and again, congrats on the quarter, guys.
George LeMaitre (CEO)
Thanks a lot, Ed.
Operator (participant)
Thank you. Our next question or comment comes from the line of Brett Fishman from KeyBanc. Mr. Fishman, your line is now open.
Brett Fishman (Equity Research Analyst)
Hey, guys. Thanks very much for taking the questions. Follow up on Artegraft. You know, 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, 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, I understand it's, it's still, like, more than a year out, but maybe like a directional range of outcomes if those launches-
George LeMaitre (CEO)
Right
Brett Fishman (Equity Research Analyst)
are in fact successful.
George LeMaitre (CEO)
Yeah, Brett, that's a fantastic question. We, we think about this, and we talk about this a lot. Maybe if I limit my comment to Europe, it's easier. Europe being sort of 50% of the rest of world besides the U.S. and Canada. You'd love to say, "Oh, it's exact- Europe is, you know, half the..." I'd say it's half the size of the U.S. You'd love financially. Let's say, you'd love to 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 million of revenue in the U.S., let's say that's kind of full, although we still plan on growing that, but let's take $33 million in the U.S., you go to $16 million, and then cut it in half, $16 million being geographically, financially, Europe's always about half as big as the U.S., and then cut that in half again. So maybe there's an $8 million TAM there, and then maybe if you wanna be really high level, you could say there's another $8 million TAM away from that in places like Japan and Korea and China.
Brett Fishman (Equity Research Analyst)
All right. Super helpful color. Appreciate that. And then, one follow-up on the product area. Another good quarter for Allograft, not too surprising, but the trends in Carotid shunts looks like they bumped up again this quarter, I think, 27%. Just curious maybe on what, what was underlying that, that level of growth and how sustainable that might be.
George LeMaitre (CEO)
Right. I mean, it's just a, it's a fantastic story that's going on with shunts, which is the main competitor or, or one of the two main competitors, Bard, left the market because they were frustrated with Brussels and the whole new CE MDR thing. So they just said, "We're not gonna support this product line." So, you know, we're just taking all the, the old units from those guys. In addition, since, you know, the CE barriers have gotten higher and higher, we're taking the opportunity to put in some price changes on that product line. So you got more units because Bard left, and then because Bard's gone away and there's no new competitors coming in, you probably have better pricing. So I, I think the number was something like 17% this year, or this quarter, Q1. What was it?
J.J. Pellegrino (CFO)
27%.
George LeMaitre (CEO)
Sorry, 27% was our up, Brett, in that. So excellent activity going on there. Despite TCAR, despite stent, stenting and all that, it's been, it's been a fantastic run.
Brett Fishman (Equity Research Analyst)
All right. Appreciate you taking the questions, and congrats on the quarter, guys.
George LeMaitre (CEO)
Thanks a lot, Brett.
Operator (participant)
Thank you. I'm sure 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 a great day.