LeMaitre Vascular Inc

NASDAQ:LMAT

Earnings Call Transcript 2024-Q1

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

[Joseph Pellegrino, executive]

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. However 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-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, executive]

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 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.

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 8 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 approvals by the end of 2025.

Our Artegraft CE Mark filing was made in December 2023. And when we acquired Artegraft in 2020, it was cleared for sale only in the U.S. so receiving European approval will 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. And with that, I'll turn the call over to JJ.

[Joseph Pellegrino, executive]

Thanks, George. We continue to apply pricing force 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 P&L.

In Chicago, our Allograft 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% 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 to $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 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%. With that, I'll turn it back over to the operator for questions.

[Operator]

[Operator Instructions]. Our first question or comment comes from the line of Rick Wise from Stifel.

[Frederick Wise, analyst]

George, maybe I -- first, I guess I must say, in fact, the proverbial congratulations on another excellent quarter. 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?

[George LeMaitre, executive]

Thanks for the good question, Rick. Yes, it's been a little bit slow, probably inside your question, you pointed 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. 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 scripts, we're definitely hiring in North America, almost exclusively. There's one or 2 in Europe and one or 2 in Asia right now. So no, I think we'll get there. It's still -- we're still 8 months left in the year to get there and hiring is not that hard. It's doable. So we feel comfortable where we are and as for how we're getting these, I think to stylize it, 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 once something gets that big, you probably should put it in half. And on average, all of our territories in the U.S. are at that size now.

[Frederick Wise, analyst]

Got you. 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 are appreciating?

[Joseph Pellegrino, executive]

Yes. I would say it's 2 or 3 things we're -- average price increases the DL efficiencies and quality costs. And I would expect those to continue as we go through the year.

[George LeMaitre, executive]

And so Rick, part of the 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 margin 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.

[Joseph Pellegrino, executive]

Yes. And in terms of the price increases, Rick, I would say those are probably adding 2%, 2.5% of 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 3 favorable trends happening through the rest of the year as well.

[Frederick Wise, analyst]

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 team here is just the sustainability of the kind of impressive growth you're turning in, 44% in Asia and 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, is there upside from here? Just any incremental perspective there, George, would be welcome.

[George LeMaitre, executive]

Sure. Thanks for a great question, Rick, and I appreciate how you frame that. I think particularly to Asia Pac, what you're seeing over here in the last 5 years is a repeat of what we did in Europe back and I'm going to call it the odds and the 10s. I don't even know what you're supposed to call us 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 is 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 -- 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.

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 #1 product line is Artegraft. And then RFA is not that far behind or allografts at least 2 words are very close. Artegraft and allograft are the 2 biggies in the U.S., 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.

[Operator]

[Operator Instructions] Our next question or comment comes from the line of Suraj Kalia from Oppenheimer.

[Suraj Kalia, analyst]

George, can you hear me all right?

[George LeMaitre, executive]

I can, Suraj.

[Suraj Kalia, analyst]

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?

[George LeMaitre, executive]

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

[Suraj Kalia, analyst]

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

[George LeMaitre, executive]

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, analyst]

Got it. And George, one final question. Obviously, there's been a large strategic that has just surprised everyone with take-out multiples. And you guys have been relatively very disciplined on M&A and basically showcasing to the Street in terms of your strategy. And David has been very articulate on 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 you are seeing it? What should we think about as the year progresses?

[David Roberts, executive]

Suraj, it's Dave. If you don't mind, I'll jump in. You mentioned the multiples you're probably referring to the J&J Shockwave in the roughly 18x 2023 revenue. That was obviously a huge announcement in our space. 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 Peters Surgical in Europe for less than 2x sales.

So valuation always depends on what you're buying. Of course, I think I read your reports, and I see small cap med tech valued around 4 to 5x sales. So I mean we are -- I'd say we are very -- we do focus on valuation lot. I'd say more than that, we focus on strategic fit. And so for us, finding the right target, which ideally isn't open to vascular targets. They're about $25 million with more than $5 million 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 are a little bit larger that we're talking to, but 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, analyst]

That should be good enough. Congrats again.

[Operator]

Our next question or comment comes from the line of Daniel Stauder from Citizens JMP.

[Daniel Stauder, analyst]

Yes. Great. So 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 and the year, 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? Is it mainly from sales rep utilization? And how are you continuing to drive this throughout the year?

[George LeMaitre, executive]

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 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&L.

And then also the 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 68.0%. As we were preparing our guidance and everything, we kept off expenses exactly the same.

[Joseph Pellegrino, executive]

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. 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.

[George LeMaitre, executive]

I hope that gets to your question, Daniel.

[Daniel Stauder, analyst]

Yes. That was great. And then just one follow-up, more along the lines of the revenue guidance and the cadence in the back half. Typically, 3Q steps down from Q2. 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? And I know you have some pretty tough comps in 3Q and 4Q. So I just wanted to get your thoughts on your confidence in second half sales growth as you sit here today?

[Joseph Pellegrino, executive]

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 #1 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. 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 maybe a little bit more robust than it seems. We beat by, what, $1.7 million, $1.8 million in Q1 and now we're given an extra 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, analyst]

Congrats on the great quarter.

[Operator]

Our next question or comment comes from the line of Michael Sarcone from Jefferies.

[Michael Sarcone, analyst]

That's like our -- the AMP said 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?

[George LeMaitre, executive]

Right. So Michael, I try to make a real point of not guiding past Q4 of '24 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 9-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, analyst]

All right. Great. That's helpful. And then just a question around the ERP system you've talked about, you mentioned real-time reporting, financial processes and more sophisticated analytics, was wondering if you could speak to -- does this help at all who sales force productivity in any way? And then on the expense side, 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, executive]

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 the 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.

[Joseph Pellegrino, executive]

Mike as an example, our analytics tool is homegrown. And the analytics tools homegrown by our IT folks who did a phenomenal job, and it does a really nice job of getting data to folks quickly in 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.

[Michael Sarcone, analyst]

That's helpful, JJ. 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 larger ERP systems. Just one last one for me that I'll squeeze in. Could you just give us an update on how things are going with Aziyo and how you're thinking there?

[David Roberts, executive]

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 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 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.

[Operator]

Our next question or comment comes from the line of James Sidoti from Sidoti & Company.

[Unknown Analyst]

This is Alex on for Jim. A couple of quick ones for me. We spoke about GLPs, effect on cardiovascular event reductions in the fall. It sounded like there wasn't a meaningful effect. I just wanted to check in on that and see if that's still helps.

[George LeMaitre, executive]

Yes. Okay. Thanks for your question, Alex. It's George. We have not seen anything in the whole sort of thing kind of came and went. From our perspective, sort of as a Wall Street bruhaha. we feel comfortable that our business proceeds with or without GLP. So no effect up here.

[Unknown Analyst]

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

[George LeMaitre, executive]

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 1.5 years ago, and instead of renting a new building, what we did as we went into one of our buildings, 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, 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 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. That might lead to more allograft growth going forward, but we shall see and we don't really guide by product line.

[Operator]

Our next question or comment comes from the line of Brooks O'Neil from Lake Street Capital Markets.

[Unknown Analyst]

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 the split moving forward throughout the year if you have that info?

[George LeMaitre, executive]

Yes. And you want Q1 or Q4?

[Unknown Analyst]

Sorry, Q1?

[George LeMaitre, executive]

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 sixth inning of price hikes. Maybe we still have something to go with that.

[Joseph Pellegrino, executive]

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 restore flow and some of our catheters and Omniflow. And if you thought about it last year, it was more 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.

[Unknown Analyst]

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

[George LeMaitre, executive]

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'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 #1 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 train or a dedicated sales trainer. And that will be the first one that we've had, and it feels like or 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.

[Unknown Analyst]

Congrats on the quarter.

[Operator]

Our next question or comment comes from the line of Brett Fishbin from KeyBanc.

[Brett Fishbin, analyst]

Follow-up on Artegraft 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 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.

[George LeMaitre, executive]

Yes. Brett, that's a fantastic question. We think about this when 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 the world, besides the U.S. and Canada. You'd love to say, "Oh, it's exactly -- Europe is half this -- I would say it's half the size of the U.S. you love it financially, let's say, you'd let's say it's half of that. But then I cut that in half again, but 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 fall, although we still plan on growing that. But let's take 33 in the U.S., you go to 16 and then cut it in half, 16 being financially, Europe is always about half as big as the U.S. and then cut that in half again. So maybe there's an 8 TAM there. And then maybe if you want to be really high level could say there's another 8 TAM away from that in places like Japan and Korea and China.

[Brett Fishbin, analyst]

All right. Super helpful color. I 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 was 27%. Just curious maybe on what was underlying that level of growth and how sustainable that might be?

[George LeMaitre, executive]

Right? I mean it's just -- it's a fantastic story that's going on with shunts, which is -- the main competitor were one of the 2 main competitors barred left the market because they were frustrated with Brussels and the whole new CE MDR thing. 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, and 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 think the number was something like 17% this year -- this quarter, Q1.

[Brett Fishbin, analyst]

What was 27%?

[George LeMaitre, executive]

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.

[Brett Fishbin, analyst]

Congrats on the quarter, guys.

[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 a great day.