Document and Entity Information - shares	9 Months Ended
Document and Entity Information - shares	Sep. 30, 2018	Nov. 05, 2018
Document Information [Abstract]
Entity Registrant Name	MERIT MEDICAL SYSTEMS INC
Entity Central Index Key	0000856982
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Document Type	10-Q
Document Period End Date	Sep. 30, 2018
Document Fiscal Year Focus	2018
Document Fiscal Period Focus	Q3
Amendment Flag	false
Entity Emerging Growth Company	false
Entity Small Business	false
Entity Common Stock, Shares Outstanding		54,833,602

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
CURRENT ASSETS:
Cash and cash equivalents	$ 51,955	$ 32,336
Trade receivables — net of allowance for uncollectible accounts — 2018 — $1,921 and 2017 — $1,769	129,282	105,536
Other receivables	8,903	9,429
Inventories	181,439	155,288
Prepaid expenses and other assets	11,720	9,096
Prepaid income taxes	3,307	3,225
Income tax refund receivables	1,043	1,211
Total current assets	387,649	316,121
PROPERTY AND EQUIPMENT:
Land and land improvements	26,926	19,877
Buildings	150,880	147,356
Manufacturing equipment	211,215	197,651
Furniture and fixtures	53,869	49,528
Leasehold improvements	33,365	31,161
Construction-in-progress	48,166	32,896
Total property and equipment	524,421	478,469
Less accumulated depreciation	(204,496)	(185,649)
Property and equipment — net	319,925	292,820
OTHER ASSETS:
Goodwill	249,023	238,147
Deferred income tax assets	2,254	2,359
Other assets	61,927	35,040
Total other assets	602,309	502,870
TOTAL	1,309,883	1,111,811
CURRENT LIABILITIES:
Trade payables	50,697	34,931
Accrued expenses	65,530	58,932
Current portion of long-term debt	22,000	19,459
Income taxes payable	1,598	2,298
Total current liabilities	139,825	115,620
LONG-TERM DEBT	186,867	259,013
DEFERRED INCOME TAX LIABILITIES	23,102	23,289
LONG-TERM INCOME TAXES PAYABLE	4,846	4,846
LIABILITIES RELATED TO UNRECOGNIZED TAX BENEFITS	2,746	2,746
DEFERRED COMPENSATION PAYABLE	12,176	11,181
DEFERRED CREDITS	2,296	2,403
OTHER LONG-TERM OBLIGATIONS	14,814	16,379
Total liabilities	386,672	435,477
COMMITMENTS AND CONTINGENCIES (Notes 5, 10, 11, and 14)
STOCKHOLDERS’ EQUITY:
Preferred stock — 5,000 shares authorized as of September 30, 2018 and December 31, 2017; no shares issued	0	0
Common stock, no par value; shares authorized — 2018 and 2017 - 100,000; issued and outstanding as of September 30, 2018 - 54,802 and December 31, 2017 - 50,248	568,051	353,392
Retained earnings	354,236	321,408
Accumulated other comprehensive income	924	1,534
Total stockholders’ equity	923,211	676,334
TOTAL	1,309,883	1,111,811
Developed technology — net of accumulated amortization — 2018 — $93,680 and 2017 — $72,420
OTHER ASSETS:
Intangible assets	224,540	167,771
Other — net of accumulated amortization — 2018 — $46,088 and 2017 — $38,127
OTHER ASSETS:
Intangible assets	$ 64,565	$ 59,553

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
CURRENT ASSETS:
Trade receivables, allowances	$ 2,011	$ 1,769
STOCKHOLDERS’ EQUITY:
Preferred stock shares authorized (in shares)	5,000,000	5,000,000
Preferred stock shares issued (in shares)	0	0
Common stock par value (in dollars per share)
Common stock shares authorized (in shares)	100,000,000	100,000,000
Common stock shares issued (in shares)	54,802,000	50,248,000
Common stock shares outstanding (in shares)	54,802,000	50,248,000
Developed technology
OTHER ASSETS:
Intangibles, accumulated amortization	$ 93,680	$ 72,420
Other
OTHER ASSETS:
Intangibles, accumulated amortization	$ 46,088	$ 38,127

CONSOLIDATED STATEMENTS OF INCOME - USD ($) shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Income Statement [Abstract]
NET SALES	$ 221,659,000	$ 179,337,000	$ 649,504,000	$ 536,955,000
COST OF SALES	119,620,000	98,823,000	359,400,000	296,358,000
GROSS PROFIT	102,039,000	80,514,000	290,104,000	240,597,000
OPERATING EXPENSES:
Selling, general and administrative	66,382,000	54,716,000	200,389,000	169,896,000
Research and development	14,525,000	12,838,000	44,163,000	38,676,000
Intangible asset impairment charge	657,000	0	657,000	0
Contingent consideration expense (benefit)	(661,000)	20,000	(442,000)	39,000
Acquired in-process research and development	75,000	12,061,000	382,000	12,136,000
Total operating expenses	80,978,000	79,635,000	245,149,000	220,747,000
INCOME FROM OPERATIONS	21,061,000	879,000	44,955,000	19,850,000
OTHER INCOME (EXPENSE):
Interest income	359,000	94,000	847,000	266,000
Interest expense	(2,329,000)	(1,590,000)	(8,064,000)	(5,935,000)
Gain on bargain purchase	0	(778,000)	0	10,796,000
Other income (expense) - net	294,000	(810,000)	(429,000)	(376,000)
Other income (expense) — net	(1,676,000)	(3,084,000)	(7,646,000)	4,751,000
INCOME (LOSS) BEFORE INCOME TAXES	19,385,000	(2,205,000)	37,309,000	24,601,000
INCOME TAX EXPENSE	2,766,000	1,364,000	4,481,000	3,884,000
NET INCOME (LOSS)	$ 16,619,000	$ (3,569,000)	$ 32,828,000	$ 20,717,000
EARNINGS PER COMMON SHARE:
Basic (in dollars per share)	$ 0.31	$ (0.07)	$ 0.64	$ 0.43
Diluted (in dollars per share)	$ 0.30	$ (0.07)	$ 0.62	$ 0.42
AVERAGE COMMON SHARES:
Basic (in shares)	53,431	50,150	51,434	48,332
Diluted (in shares)	55,103	51,599	53,096	49,555

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Statement of Comprehensive Income [Abstract]
Net income	$ 16,619	$ (3,569)	$ 32,828	$ 20,717
Other comprehensive income (loss):
Cash flow hedges	667	(144)	3,541	166
Less income tax benefit (expense)	(172)	56	(910)	(64)
Foreign currency translation adjustment	(1,637)	721	(3,241)	2,925
Less income tax (expense)	0	0	0	(252)
Total other comprehensive income (loss)	(1,142)	633	(610)	2,775
Total comprehensive income (loss)	$ 15,477	$ (2,936)	$ 32,218	$ 23,492

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References + Details

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
CASH FLOWS FROM OPERATING ACTIVITIES:
Net income	$ 32,828	$ 20,717
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	50,436	39,388
Gain on bargain purchase	0	(10,796)
Loss on sales and/or abandonment of property and equipment	425	219
Write-off of patents and intangible assets	744	86
Acquired in-process research and development	382	12,136
Amortization of deferred credits	(106)	(111)
Amortization of long-term debt issuance costs	603	514
Deferred income taxes	0	(290)
Stock-based compensation expense	4,494	2,883
Changes in operating assets and liabilities, net of effects from acquisitions:
Trade receivables	(25,482)	(10,963)
Other receivables	255	(449)
Inventories	(19,375)	(9,922)
Prepaid expenses and other current assets	(2,719)	(1,587)
Prepaid income taxes	(120)	(231)
Income tax refund receivables	134	280
Other assets	(1,370)	(2,992)
Trade payables	15,936	(876)
Accrued expenses	7,707	4,470
Income taxes payable	(1,528)	(764)
Deferred compensation payable	994	1,107
Other long-term obligations	(1,381)	574
Total adjustments	30,029	22,676
Net cash provided by operating activities	62,857	43,393
Capital expenditures for:
Property and equipment	(47,024)	(29,522)
Intangible assets	(2,234)	(1,927)
Proceeds from the sale of property and equipment	7	9
Issuance of note receivable	(10,750)	0
Cash paid in acquisitions, net of cash acquired	(122,770)	(103,500)
Net cash used in investing activities	(182,771)	(134,940)
CASH FLOWS FROM FINANCING ACTIVITIES:
Proceeds from issuance of common stock	213,276	143,069
Offering costs	(366)	(816)
Proceeds from issuance of long-term debt	380,825	151,462
Payments on long-term debt	(450,575)	(197,962)
Contingent payments related to acquisitions	(184)	(45)
Payment of taxes related to an exchange of common stock	(2,616)	0
Net cash provided by financing activities	140,360	95,708
EFFECT OF EXCHANGE RATES ON CASH	(827)	30
NET INCREASE IN CASH AND CASH EQUIVALENTS	19,619	4,191
CASH AND CASH EQUIVALENTS:
Beginning of period	32,336	19,171
End of period	51,955	23,362
SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION
Interest (net of capitalized interest of $468 and $371, respectively)	8,018	5,953
Income taxes	6,069	4,029
Cash Flow, Noncash Investing and Financing Activities Disclosure [Abstract]
Property and equipment purchases in accounts payable	3,058	1,394
Acquisition purchases in accrued expenses and other long-term obligations	0	12,000
Merit common stock surrendered (43 and 0 shares, respectively) in exchange for exercise of stock options	$ 2,262	$ 0

CONSOLIDATED STATEMENTS OF CASH FLOWS (Parenthetical) - USD ($) shares in Thousands, $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Statement of Cash Flows [Abstract]
Net capitalized interest	$ 468	$ 371
Merit common stock surrendered in exchange for exercise of stock options (in shares)	43	0

Basis of Presentation	9 Months Ended
Basis of Presentation	Sep. 30, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation. The interim consolidated financial statements of Merit Medical Systems, Inc. ("Merit," "we" or "us") for the three and nine-month periods ended September 30, 2018 and 2017 are not audited. Our consolidated financial statements are prepared in accordance with the requirements for unaudited interim periods and, consequently, do not include all disclosures required to be made in conformity with accounting principles generally accepted in the United States of America. In the opinion of our management, the accompanying consolidated financial statements contain all adjustments, consisting of normal recurring accruals, necessary for a fair presentation of our financial position as of September 30, 2018 and December 31, 2017, and our results of operations and cash flows for the three and nine-month periods ended September 30, 2018 and 2017. The results of operations for the three and nine-month periods ended September 30, 2018 and 2017 are not necessarily indicative of the results for a full-year period. These interim consolidated financial statements should be read in conjunction with the financial statements included in our Annual Report on Form 10-K (the "2017 Form 10-K") for the year ended December 31, 2017, which was filed with the Securities and Exchange Commission (the "SEC") on March 1, 2018.

Stock-Based Compensation Expense

9 Months Ended

Sep. 30, 2018

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Stock-Based Compensation Expense

Stock-Based Compensation Expense. Stock-based compensation expense before income tax expense for the three and nine months ended September 30, 2018 and 2017, consisted of the following (in thousands):


	Three Months Ended September 30,						Nine Months Ended September 30,
	2018		2017		2018		2017
Cost of sales	$	241	$	189	$	657	$	453
Research and development	141		110		412		262
Selling, general and administrative	1,291		893		3,425		2,168
Stock-based compensation expense before taxes	$	1,673	$	1,192	$	4,494	$	2,883

We recognize stock-based compensation expense (net of a forfeiture rate) for those awards which are expected to vest on a straight-line basis over the requisite service period. We estimate the forfeiture rate based on our historical experience and expectations about future forfeitures. As of September 30, 2018, the total remaining unrecognized compensation cost related to non-vested stock options, net of expected forfeitures, was approximately $20.7 million and is expected to be recognized over a weighted average period of 3.25 years.

During the three-month period ended September 30, 2018, we did not grant any new stock-based awards. During the nine-month period ended September 30, 2018, we granted stock-based awards representing 692,002 shares of our common stock. During the three and nine-month periods ended September 30, 2017, we granted stock-based awards representing 20,000 and approximately 1.3 million shares of our common stock, respectively. We use the Black-Scholes methodology to value the stock-based compensation expense for options. In applying the Black-Scholes methodology to the option grants, the fair value of our stock-based awards granted was estimated using the following assumptions for the periods indicated below:


	Nine Months Ended September 30,
	2018	2017
Risk-free interest rate	2.63% - 2.77%	1.77% - 1.83%
Expected option life	5.0 years	5.0 years
Expected dividend yield	—	—
Expected price volatility	34.06% - 34.32%	33.81% - 34.07%

The average risk-free interest rate is determined using the U.S. Treasury rate in effect as of the date of grant, based on the expected term of the stock options. We determine the expected term of the stock options using the historical exercise behavior of employees. The expected price volatility was determined using a weighted average of daily historical volatility of our stock price over the corresponding expected option life and implied volatility based on recent trends of the daily historical volatility. For options with a vesting period, compensation expense is recognized on a straight-line basis over the service period, which corresponds to the vesting period.

Earnings Per Common Share (EPS)

9 Months Ended

Sep. 30, 2018

Earnings Per Share, Basic and Diluted [Abstract]

Earnings Per Common Share (EPS)

Earnings Per Common Share (EPS). The computation of weighted average shares outstanding and the basic and diluted earnings per common share for the following periods consisted of the following (in thousands, except per share amounts):


	Three Months								Nine Months
	Net Income		Shares	Per Share Amount		Net Income		Shares	Per Share Amount
Period ended September 30, 2018:
Basic EPS	$	16,619	53,431	$	0.31	$	32,828	51,434	$	0.64
Effect of dilutive stock options and warrants			1,672					1,662

Diluted EPS	$	16,619	55,103	$	0.30	$	32,828	53,096	$	0.62

Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive			667					462

Period ended September 30, 2017:
Basic EPS	$	(3,569)	50,150	$	(0.07)	$	20,717	48,332	$	0.43
Effect of dilutive stock options and warrants			1,449					1,223

Diluted EPS	$	(3,569)	51,599	$	(0.07)	$	20,717	49,555	$	0.42

Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive			200					434

Acquisitions

9 Months Ended

Sep. 30, 2018

Business Combinations [Abstract]

Acquisitions

Acquisitions. During July 2018, we purchased 1,786,000 preferred limited liability company units of Cagent Vascular, LLC, a medical device company ("Cagent"), for approximately $2.2 million. Our investment has been accounted for as an equity investment reflected within other assets in the accompanying consolidated balance sheets because we are not able to exercise significant influence over the operations of Cagent. Our total investment in Cagent represents an ownership of approximately 19.5% of the outstanding limited liability company units.On May 23, 2018, we entered into an asset purchase agreement with DirectACCESS Medical, LLC (“DirectACCESS”) to acquire its assets, including, certain product distribution agreements for the FirstChoice™ Ultra High Pressure PTA Balloon Catheter. We accounted for this acquisition as a business combination. The purchase price for the assets was approximately $7.3 million. The sales and results of operations related to the acquisition have been included in our cardiovascular segment since the acquisition date and were not material. Acquisition-related costs associated with the DirectACCESS acquisition, which were included in selling, general and administrative expenses in our consolidated statements of income, were not material. The purchase price was preliminarily allocated as follows (in thousands):


Inventories	$	971
Intangibles
Developed technology	4,840
Customer list	120
Trademarks	400
Goodwill	938

Total assets acquired	$	7,269

We are amortizing the developed technology intangible asset over ten years, the related trademarks over ten years and the customer list on an accelerated basis over five years. The total weighted-average amortization period for these acquired intangible assets is approximately 9.9 years.

On May 18, 2018, we paid $750,000 for a distribution agreement with QXMédical, LLC ("QXMédical") for the Q50® PLUS Stent Graft Balloon Catheter. We accounted for this acquisition as an asset purchase. We are amortizing the distribution agreement as an intangible asset over a period of ten years.

On April 6, 2018, we entered into long-term agreements with NinePoint Medical, Inc. (“NinePoint”), pursuant to which, we (a) became the exclusive worldwide distributor for the NvisionVLE® Imaging System with Real-time Targeting™ using Optical Coherence Tomography (OCT) and (b) acquired an option to purchase up to 100% of the outstanding equity in NinePoint throughout a three-month period commencing 18 months subsequent to the agreement date, both in exchange for total consideration of $10.0 million. We accounted for this transaction as an asset purchase. The results of operations related to the distribution agreement have been included in our endoscopy operating segment since the acquisition date. During the three and nine months ended September 30, 2018, our net sales of NinePoint products were approximately $1.4 million and $2.5 million, respectively. We believe the NinePoint products will enhance the product offerings of our endoscopy operating segment and will be another step in our strategy to add therapy and disease-state products to our portfolio. The NinePoint products have 510(k) clearance in the United States, and NinePoint is preparing a CE mark application. We plan to launch the NinePoint products globally on a measured basis.

In addition, on April 6, 2018, we made a loan to NinePoint for $10.5 million with a maturity date of April 6, 2023, at which time the loan, together with accrued interest thereon, will be due and payable. The loan bears interest at an annual rate of 9% and is collateralized by NinePoint's rights, interest and title to the NvisionVLE® Imaging System and substantially all other assets of NinePoint. This loan has been recorded as a note receivable within other long-term assets in our consolidated balance sheets.

On February 14, 2018, we acquired certain divested assets from Becton, Dickinson and Company ("BD"), for an aggregate purchase price of $100.3 million. The assets acquired include the soft tissue core needle biopsy products sold under the tradenames of Achieve® Programmable Automatic Biopsy System, Temno® Biopsy System, Tru-Cut® Biopsy Needles as well as Aspira® Pleural Effusion Drainage Kits, and the Aspira® Peritoneal Drainage System. We accounted for this acquisition as a business combination.

During the three and nine-month periods ended September 30, 2018, our net sales of BD products were approximately $11.8 million and $30.3 million, respectively. It is not practical to separately report earnings related to the products acquired from BD, as we cannot split out sales costs related solely to the products we acquired from BD, principally because our sales representatives sell multiple products (including the products we acquired from BD) in our cardiovascular business segment. Acquisition-related costs associated with the BD acquisition, which are included in selling, general and administrative expenses in the accompanying consolidated statements of income, were approximately $1.8 million for the nine-month period ended September 30, 2018. The following table summarizes the purchase price allocated to the assets acquired from BD (in thousands):


Inventories	$	5,804
Property and equipment	748
Intangibles
Developed technology	74,000
Customer list	4,200
Trademarks	4,900
Goodwill	10,613

Total assets acquired	$	100,265

We are amortizing the developed technology intangible assets over eight years, the related trademarks over nine years, and the customer lists on an accelerated basis over seven years. The total weighted-average amortization period for these acquired intangible assets is approximately eight years.

On October 2, 2017, we acquired a custom procedure pack business located in Melbourne, Australia from ITL Healthcare Pty Ltd. ("ITL"), for an aggregate purchase price of $11.3 million. We accounted for this acquisition as a business combination. The following table summarizes the aggregate purchase price allocated to the assets acquired from ITL (in thousands):


Assets Acquired
Trade receivables	$	1,287
Other receivables	56
Inventories	1,808
Prepaid expenses and other assets	65
Property and equipment	1,053
Intangibles
Customer lists	5,940
Goodwill	3,945
Total assets acquired	14,154

Liabilities Assumed
Trade payables	(216)
Accrued expenses	(747)
Deferred income tax liabilities	(1,901)
Total liabilities assumed	(2,864)

Total net assets acquired	$	11,290

We are amortizing the customer list on an accelerated basis over seven years. Acquisition-related costs associated with the ITL acquisition, which were included in selling, general and administrative expenses in the consolidated statements of income in the 2017 Form 10-K, were not material. The results of operations related to this acquisition have been included in our cardiovascular operating segment since the acquisition date. During the three and nine months ended September 30, 2018, our net sales of ITL products were approximately $1.9 million and $6.1 million, respectively. It is not practical to separately report the earnings related to the ITL acquisition, as we cannot split out sales costs related solely to the products we acquired from ITL, principally because our sales representatives sell multiple products (including the products we acquired from ITL) in our cardiovascular business segment.

On August 4, 2017, we acquired from Laurane Medical S.A.S. ("Laurane") and its shareholders inventories and the intellectual property rights associated with certain manual bone biopsy devices, manual bone marrow needles and muscle biopsy kits for an aggregate purchase price of $16.5 million. We also recorded a contingent consideration liability of $5.5 million related to royalties potentially payable to Laurane's shareholders pursuant to the terms of an intellectual property purchase agreement. We accounted for this acquisition as a business combination. The following table summarizes the aggregate purchase price (including contingent royalty payment liabilities) allocated to the assets acquired from Laurane (in thousands):


Inventories	$	594
Intangibles
Developed technology	14,920
Customer list	120
Goodwill	6,366

Total assets acquired	$	22,000

We are amortizing the developed technology intangible asset over 12 years and the customer list on an accelerated basis over one year. The total weighted-average amortization period for these acquired intangible assets is 11.9 years. The sales and results of operations related to the acquisition have been included in our cardiovascular segment since the acquisition date and were not material. Acquisition-related costs associated with the Laurane acquisition, which were included in selling, general and administrative expenses in the consolidated statements of income of our 2017 Form 10-K, were not material.

On July 3, 2017, we acquired from Osseon LLC (“Osseon”) substantially all the assets related to Osseon’s vertebral augmentation products. We accounted for this acquisition as a business combination. The purchase price for the assets was approximately $6.8 million. Acquisition-related costs associated with the Osseon acquisition, which were included in selling, general and administrative expenses in the consolidated statements of income of our 2017 Form 10-K, were not material. The results of operations related to this acquisition have been included in our cardiovascular segment since the acquisition date. During the three and nine months ended September 30, 2018, our net sales of Osseon products were approximately $478,000 and $1.6 million, respectively. It is not practical to separately report the earnings related to the Osseon acquisition, as we cannot split out sales costs related solely to the products we acquired from Osseon, principally because our sales representatives sell multiple products (including the products we acquired from Osseon) in our cardiovascular business segment. The following table summarizes the purchase price allocated to the assets acquired (in thousands):


Inventories	$	979
Property and equipment	58
Intangibles
Developed technology	5,400
Customer list	200
Goodwill	203

Total assets acquired	$	6,840

We are amortizing the developed technology intangible asset over nine years and customer lists on an accelerated basis over eight years. The total weighted-average amortization period for these acquired intangible assets is approximately 9.0 years.

On May 1, 2017, we entered into an agreement and plan of merger with Vascular Access Technologies, Inc. ("VAT"), pursuant to which we acquired the SAFECVAD™ device. We accounted for this acquisition as a business combination. The purchase price for the acquisition was $5.0 million. We also recorded $4.9 million of contingent consideration related to royalties potentially payable to VAT pursuant to the merger agreement. The following table summarizes the purchase price allocated to the net assets acquired (in thousands):


Intangibles
Developed technology	$	7,800
In-process technology	920
Goodwill	4,281
Deferred tax liabilities	(3,101)

Total net assets acquired	$	9,900

We are amortizing the developed technology intangible asset over 15 years. The sales and results of operations related to the acquisition have been included in our cardiovascular segment since the acquisition date and were not material. Acquisition-related costs associated with the VAT acquisition, which were included in selling, general and administrative expenses in the consolidated statements of income of our 2017 Form 10-K, were not material.

On January 31, 2017, we acquired the critical care division of Argon Medical Devices, Inc. ("Argon"), including a manufacturing facility in Singapore, the related commercial operations in Europe and Japan, and certain inventories and intellectual property rights within the United States. We made an initial payment of approximately $10.9 million and received a subsequent reduction to the purchase price of approximately $797,000 related to a working capital adjustment according to the terms of the purchase agreement. We accounted for the acquisition as a business combination.

Acquisition-related costs associated with the acquisition of the Argon critical care division during the year ended December 31, 2017, which were included in selling, general and administrative expenses in the consolidated statements of income of our 2017 Form 10-K, were approximately $2.6 million. The results of operations related to this acquisition have been included in our cardiovascular segment since the acquisition date. During the three and nine months ended September 30, 2018, our net sales of the Argon critical care products were approximately $11.0 million and $34.2 million, respectively. It is not practical to separately report the earnings related to the Argon critical care acquisition, as we cannot split out sales costs related solely to the products we acquired from Argon, principally because our sales representatives sell multiple products (including the products we acquired from Argon) in our cardiovascular business segment.

The assets and liabilities in the purchase price allocation for the Argon critical care acquisition are stated at fair value based on estimates of fair value using available information and making assumptions our management believes are reasonable. The following table summarizes the purchase price allocated to the net tangible and intangible assets acquired and liabilities assumed (in thousands):


	Assets Acquired
	Cash and cash equivalents	$	1,436
	Trade receivables	8,351
	Inventories	11,222
	Prepaid expenses and other assets	1,275
	Income tax refund receivables	165
	Property and equipment	2,319
	Deferred income tax assets	202
	Intangibles
	Developed technology	2,200
	Customer lists	1,500
	Trademarks	900
	Total assets acquired	29,570

	Liabilities Assumed
	Trade payables	(2,414)
	Accrued expenses	(5,083)
	Deferred income tax liabilities	(934)
	Total liabilities assumed	(8,431)

	Total net assets acquired	21,139
	Gain on bargain purchase ⁽¹⁾	(11,039)
	Total purchase price	$	10,100

⁽¹⁾	The total fair value of the net assets acquired from Argon exceeded the purchase price, resulting in a gain on bargain purchase which was recorded within other income (expense) in our consolidated statements of income. We believe the reason for the gain on bargain purchase was a result of the divestiture of a non-strategic, slow-growth critical care business for Argon. It is our understanding that the divestiture allows Argon to focus on its higher growth interventional portfolio. A reduction of $1.2 million was recorded since the bargain purchase gain was first presented in our Quarterly Report on Form 10-Q for the quarter ended March 31, 2017, resulting from our ongoing activities, including reassessment of the assets acquired and liabilities assumed. The purchase price allocation for this acquisition is now final.

With respect to the Argon critical care assets, we are amortizing developed technology over seven years and customer lists on an accelerated basis over five years. While U.S. trademarks can be renewed indefinitely, we estimate that we will generate cash flow from the acquired trademarks for a period of five years from the acquisition date. The total weighted-average amortization period for these acquired intangible assets is approximately 6.0 years.

On January 31, 2017, we acquired substantially all the assets, including intellectual property covered by approximately 40 patents and pending applications, and assumed certain liabilities, of Catheter Connections, Inc. (“Catheter Connections”), in exchange for payment of $38.0 million. Catheter Connections, based in Salt Lake City, Utah, developed and marketed the DualCap® System, an innovative family of disinfecting products designed to protect patients from intravenous infections resulting from infusion therapy. We accounted for this acquisition as a business combination.

Acquisition-related costs associated with the Catheter Connections acquisition during the year ended December 31, 2017, which were included in selling, general and administrative expenses were approximately $482,000. The results of operations related to this acquisition have been included in our cardiovascular operating segment since the acquisition date. During the three and nine months ended September 30, 2018, our net sales of the products acquired from Catheter Connections were approximately $3.7 million and $10.1 million, respectively. It is not practical to separately report the earnings related to the products acquired from Catheter Connections, as we cannot split out sales costs related solely to those products, principally because our sales representatives sell multiple products (including the DualCap System) in the cardiovascular business segment. The purchase price was allocated as follows (in thousands):


Assets Acquired
Trade receivables	$	958
Inventories	2,157
Prepaid expenses and other assets	85
Property and equipment	1,472
Intangibles
Developed technology	21,100
Customer lists	700
Trademarks	2,900
Goodwill	8,989
Total assets acquired	38,361

Liabilities Assumed
Trade payables	(338)
Accrued expenses	(23)
Total liabilities assumed	(361)

Total net assets acquired	$	38,000

We are amortizing the Catheter Connections developed technology asset over 12 years, the related trademarks over ten years, and the associated customer list on an accelerated basis over eight years. We have estimated the weighted average life of the intangible Catheter Connections assets acquired to be approximately 11.7 years.

The following table summarizes our consolidated results of operations for the nine-month period ended September 30, 2017, as well as unaudited pro forma consolidated results of operations as though the acquisition of the Argon critical care division had occurred on January 1, 2016 (in thousands, except per common share amounts):


	Nine Months Ended
	September 30, 2017
	As Reported		Pro Forma
Net sales	$	536,955	$	539,715
Net income	20,717		10,039
Earnings per common share:
Basic	$	0.43	$	0.21
Diluted	$	0.42	$	0.20

* The pro forma results for the three-month periods ended September 30, 2018 and 2017 and the nine-month period ended September 30, 2018 are not included in the table above because the operating results for the Argon critical care division acquisition were included in our consolidated statements of income for these periods.

The unaudited pro forma information set forth above is for informational purposes only and includes adjustments related to the step-up of acquired inventories, amortization expense of acquired intangible assets, interest expense on long-term debt and changes in the timing of the recognition of the gain on bargain purchase. The pro forma information should not be considered indicative of actual results that would have been achieved if the acquisition of the Argon critical care division had occurred on January 1, 2016, or results that may be obtained in any future period. The pro forma consolidated results of operations do not include the acquisition of assets from BD because it was deemed impracticable to obtain information to determine net income associated with the acquired product lines which represent a small product line of a large, consolidated company without standalone financial information. The pro forma consolidated results of operations do not include the DirectACCESS, ITL, Laurane, Osseon, VAT or Catheter Connections acquisitions as we do not deem the pro forma effect of these transactions to be material.

The goodwill arising from the acquisitions discussed above consists largely of the synergies and economies of scale we hope to achieve from combining the acquired assets and operations with our historical operations. The goodwill recognized from certain acquisitions is expected to be deductible for income tax purposes.

Revenue from Contracts with Customers

9 Months Ended

Sep. 30, 2018

Revenue from Contract with Customer [Abstract]

Revenue from Contract with Customers

Revenue from Contracts with Customers.

We sell our medical products through a direct sales force in the U.S. and through OEM relationships, custom procedure tray manufacturers and a combination of direct sales force and independent distributors in international markets. Revenue is recognized when a customer obtains control of promised goods based on the consideration we expect to receive in exchange for these goods. This core principle is achieved through the following steps:

Identify the contract with the customer. A contract with a customer exists when (i) we enter into an enforceable contract with a customer that defines each party’s rights regarding the goods to be transferred and identifies the payment terms related to these goods, (ii) the contract has commercial substance and, (iii) we determine that collection of substantially all consideration for services that are transferred is probable based on the customer’s intent and ability to pay the promised consideration. We do not have significant costs to obtain contracts with customers. For commissions on product sales, we have elected the practical expedient to expense the costs as incurred if the amortization period would have been one year or less.

Identify the performance obligations in the contract. Generally, our contracts with customers do not include multiple performance obligations to be completed over a period of time. Our performance obligations generally relate to delivering single-use medical products to a customer, subject to the shipping terms of the contract. Limited warranties are provided, under which we typically accept returns and provide either replacement parts or refunds. We do not have significant returns. We do not typically offer extended warranty or service plans.

Determine the transaction price. Payment by the customer is due under customary fixed payment terms, and we evaluate if collectability is reasonably assured. None of our contracts as of September 30, 2018 contained a significant financing component. Revenue is recorded at the net sales price, which includes estimates of variable consideration such as product returns, rebates, discounts, and other adjustments. The estimates of variable consideration are based on historical payment experience, historical and projected sales data, and current contract terms. Variable consideration is included in revenue only to the extent that it is probable that a significant reversal of the revenue recognized will not occur when the uncertainty associated with the variable consideration is subsequently resolved. Taxes collected from customers relating to product sales and remitted to governmental authorities are excluded from revenues.

Allocate the transaction price to performance obligations in the contract. We typically do not have multiple performance obligations in our contracts with customers. As such, we recognize revenue upon transfer of the product to the customer's control at contractually stated pricing.

Recognize revenue when or as we satisfy a performance obligation. We satisfy performance obligations at a point in time upon either shipment or delivery of goods, in accordance with the terms of each contract with the customer. We do not have significant service revenue.

Disaggregation of Revenue

The disaggregation of revenue is based on type of product and geographical region. For descriptions of our product offerings and segments, see Note 12 in our 2017 Form 10-K.

The following tables present revenue from contracts with customers for the three and nine-month periods ended September 30, 2018 and 2017 (in thousands):


	Three Months Ended September 30, 2018										Three Months Ended September 30, 2017
	United States		International		Total		United States		International		Total
Cardiovascular
Stand-alone devices	$	52,173	$	38,802	$	90,975	$	36,383	$	32,366	$	68,749
Custom kits and procedure trays	23,199		9,896		33,095		23,085		7,326		30,411
Inflation devices	7,819		15,074		22,893		8,241		11,792		20,033
Catheters	18,081		22,510		40,591		15,377		16,374		31,751
Embolization devices	5,145		7,250		12,395		5,414		6,838		12,252
CRM/EP	10,462		1,739		12,201		8,202		1,325		9,527
Total	116,879		95,271		212,150		96,702		76,021		172,723

Endoscopy
Endoscopy devices	9,229		280		9,509		6,389		225		6,614

Total	$	126,108	$	95,551	$	221,659	$	103,091	$	76,246	$	179,337


	Nine Months Ended September 30, 2018										Nine Months Ended September 30, 2017
	United States		International		Total		United States		International		Total
Cardiovascular
Stand-alone devices	$	147,125	$	119,592	$	266,717	$	109,750	$	93,709	$	203,459
Custom kits and procedure trays	69,184		31,175		100,359		68,823		22,259		91,082
Inflation devices	23,647		45,970		69,617		24,257		35,072		59,329
Catheters	50,055		63,775		113,830		46,529		47,828		94,357
Embolization devices	15,272		22,434		37,706		16,548		20,388		36,936
CRM/EP	31,058		5,105		36,163		28,212		3,765		31,977
Total	336,341		288,051		624,392		294,119		223,021		517,140

Endoscopy
Endoscopy devices	24,269		843		25,112		19,195		620		19,815

Total	$	360,610	$	288,894	$	649,504	$	313,314	$	223,641	$	536,955

Segment Reporting

9 Months Ended

Sep. 30, 2018

Segment Reporting [Abstract]

Segment Reporting

Segment Reporting. We report our operations in two operating segments: cardiovascular and endoscopy. Our cardiovascular segment consists of cardiology and radiology medical device products which assist in diagnosing and treating coronary artery disease, peripheral vascular disease and other non-vascular diseases and includes embolotherapeutic, cardiac rhythm management ("CRM"), electrophysiology ("EP"), critical care, and interventional oncology and spine devices. Our endoscopy segment focuses on the gastroenterology, pulmonary and thoracic surgery specialties, with a portfolio consisting primarily of stents, dilation balloons, certain inflation devices, guidewires, and other disposable products. We evaluate the performance of our operating segments based on operating income. Financial information relating to our reportable operating segments and reconciliations to the consolidated totals for the three and nine-month periods ended September 30, 2018 and 2017, are as follows (in thousands):


	Three Months Ended September 30,						Nine Months Ended September 30,
	2018		2017		2018		2017
Net Sales
Cardiovascular	$	212,150	$	172,723	$	624,392	$	517,140
Endoscopy	9,509		6,614		25,112		19,815
Total net sales	$	221,659	$	179,337	$	649,504	$	536,955

Operating Income (Loss)
Cardiovascular	$	18,199	$	(1,207)	$	37,263	$	14,239
Endoscopy	2,862		2,086		7,692		5,611
Total operating income	$	21,061	$	879	$	44,955	$	19,850

Recently Issued Financial Accounting Standards	9 Months Ended
Recently Issued Financial Accounting Standards	Sep. 30, 2018
Accounting Policies [Abstract]
Recently Issued Financial Accounting Standards	Recently Issued Financial Accounting Standards Recently Adopted In October 2016, the Financial Accounting Standards Board (the "FASB") issued Accounting Standards Update ("ASU") No. 2016-16, Income Taxes (Topic 740): Intra-Entity Transfers of Assets Other than Inventory, which requires the recognition of the income tax consequences of an intra-entity transfer of an asset, other than inventory, when the transfer occurs. ASU 2016-16 became effective for us as of January 1, 2018. The adoption of ASU 2016-16 did not have a material impact on our consolidated financial statements. In August 2016, the FASB issued ASU No. 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments, which addresses eight specific cash flow issues with the objective of reducing the existing diversity in practice in how certain cash receipts and cash payments are presented and classified in the statement of cash flows. We adopted ASU 2016-15 on January 1, 2018. The adoption of ASU 2016-15 did not have a material impact on our consolidated financial statements. In January 2016, the FASB issued ASU No. 2016-01, Financial Instruments - Overall: Recognition and Measurement of Financial Assets and Financial Liabilities, which amends the guidance regarding the classification and measurement of financial instruments. Changes to the current guidance primarily affect the accounting for equity investments, financial liabilities under the fair value option, and the presentation and disclosure requirements for financial instruments. In addition, ASU 2016-01 clarifies guidance related to the valuation allowance assessment when recognizing deferred tax assets resulting from unrealized losses on available-for-sale debt securities. We adopted ASU 2016-01 on January 1, 2018. The adoption of ASU 2016-01 did not have a material impact on our consolidated financial statements. In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606), which provides a single comprehensive model for entities to use in accounting for revenue arising from contracts with customers. We adopted this ASU (and all subsequent ASUs that modified Topic 606) effective January 1, 2018 on a modified retrospective basis. Adoption of this standard did not result in significant changes to our accounting policies, business processes, systems or controls, or have a material impact on our financial position, results of operations or cash flows. As such, prior period amounts are not adjusted and continue to be reported under accounting standards then in effect, and we did not record a cumulative adjustment to the opening equity balance of retained earnings as of January 1, 2018. However, additional disclosures have been added in accordance with the requirements of Topic 606 and are reflected in Note 6. Not Yet Adopted In August 2018, the FASB issued ASU 2018-15, Intangibles-Goodwill and Other-Internal-Use Software (Subtopic 350-40). The new guidance reduces complexity for the accounting for costs of implementing a cloud computing service arrangement and aligns the requirements for capitalizing implementation costs incurred in a hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software (and hosting arrangements that include an internal use software license). ASU 2018-15 is effective for fiscal years beginning after December 15, 2019, and interim periods within those fiscal years, with early adoption permitted. Implementation may be applied either retrospectively or prospectively to all implementation costs incurred after the date of adoption. We are currently evaluating the anticipated impact of adopting ASU 2018-15 on our consolidated financial statements. In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820)—Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurement, which modifies disclosure requirements related to fair value measurements. The amendments in this ASU are effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. Implementation on a prospective or retrospective basis varies by specific disclosure requirement. The standard allows for early adoption of any removed or modified disclosures upon issuance of this ASU while delaying adoption of the additional disclosures until their effective date. We are currently evaluating the anticipated impact of adopting ASU 2018-13 on our consolidated financial statements. In June 2018, the FASB issued ASU 2018-07, Compensation-Stock Compensation (Topic 718): Improvements to Nonemployee Share-Based Payment Accounting, which simplifies the accounting for nonemployee share-based payment transactions by expanding the scope of ASC Topic 718, Compensation - Stock Compensation, to include share-based payment transactions for acquiring goods and services from nonemployees. Under the new standard, most of the guidance on stock compensation payments to nonemployees would be aligned with the requirements for share-based payments granted to employees. This standard is effective for annual reporting periods beginning after December 15, 2018, and interim periods within those fiscal years, with early adoption permitted. While we continue to assess the potential impact of this standard, we do not expect the adoption of this standard to have a material impact on our consolidated financial statements. In February 2018, the FASB issued ASU 2018-02, Income Statement-Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income, which allows a reclassification from accumulated other comprehensive income to retained earnings for stranded tax effects resulting from U.S. federal tax legislation commonly referred to as the Tax Cuts and Jobs Act, which was enacted in December 2017 (the "2017 Tax Act"). ASU 2018-02 is effective for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years. Early adoption is permitted. While we continue to assess our adoption policy for this standard, we do not expect adoption to have a material impact on our consolidated financial statements. In August 2017, the FASB issued ASU 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities, which expands and refines hedge accounting for both financial and non-financial risk components, aligns the recognition and presentation of the effects of hedging instruments and hedge items in the financial statements, and includes certain targeted improvements to ease the application of current guidance related to the assessment of hedge effectiveness. ASU 2017-12 is effective for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years. Early adoption is permitted. We are currently evaluating the anticipated impact of adopting ASU 2017-12 on our consolidated financial statements. In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842), which eliminates the current tests for lease classification under U.S. GAAP and requires lessees to recognize the right-of-use assets and related lease liabilities on the balance sheet for all leases greater than one year in duration. ASU 2016-02 is effective for fiscal years beginning after December 15, 2018, including interim periods within those fiscal years. Early adoption of ASU 2016-02 is permitted. In July 2018, the FASB issued ASU 2018-11 to provide a transition practical expedient by allowing entities to initially apply the new leases standard at the adoption date, recognize a cumulative-effect adjustment to the opening balance of retained earnings in the period of adoption, and not restate prior periods. We expect to adopt this as well as certain other practical expedients available to us under the new guidance. We have implemented processes and information technology tools to assist in our ongoing lease data collection and analysis. We are currently finalizing our lease portfolio analysis to determine the impact to our consolidated financial statements, and currently expect that most of our operating lease commitments will be recognized as lease liabilities and right-of-use assets upon our adoption of ASU 2016-02. We are updating our accounting policies and internal controls that will be impacted by the new guidance to ensure readiness for adoption in the first quarter of 2019. We do not believe any other issued and not yet effective accounting standards will be relevant to our consolidated financial statements.

Income Taxes	9 Months Ended
Income Taxes	Sep. 30, 2018
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes. On December 22, 2017, the 2017 Tax Act was signed into law. At December 31, 2017, we recorded a provisional net tax benefit related to the remeasurement of deferred taxes and a one-time tax expense for the transition tax. In accordance with SEC Staff Accounting Bulletin 118, income tax effects of the 2017 Tax Act may be refined upon obtaining, preparing, and/or analyzing additional information during the measurement period and such changes could be material. During the measurement period, provisional amounts may also be adjusted for the effects, if any, of interpretative guidance issued after December 31, 2017 by U.S. regulatory and standard-setting bodies. As of September 30, 2018, the amounts recorded for the 2017 Tax Act remain provisional and may be impacted by further analysis and subsequently issued guidance. For tax years beginning after December 31, 2017, the 2017 Tax Act introduces new provisions of U.S. taxation of certain Global Intangible Low-Taxed Income (“GILTI”). We have not yet determined our policy election with respect to whether to record deferred taxes for temporary basis differences expected to reverse as GILTI in future periods, or account for taxes on GILTI using the period cost method. We have, however, included an estimate of the current GILTI impact in our tax provision for the three and nine months ended September 30, 2018. Our non-U.S. earnings are currently considered as indefinitely reinvested overseas. Previously, any repatriation by way of a dividend may have been subject to both U.S. federal and state income taxes, as adjusted for any non-U.S. tax credits. Under the 2017 Tax Act, such dividends should no longer be subject to U.S. federal tax. We are still analyzing how the 2017 Tax Act impacts our existing accounting position to indefinitely reinvest foreign earnings and have yet to determine whether we plan to change our position. We will record the tax effects of any change to our existing assertion in the period that we complete our analysis. If such earnings were to be distributed, any foreign withholding taxes could be material. Our provision for income taxes for the three months ended September 30, 2018 and 2017 was a tax expense of approximately $2.8 million and $1.4 million, respectively, which resulted in an effective tax rate of 14.3% and (61.9)%, respectively. The change in the effective tax rate for the third quarter of 2018 compared to the third quarter of 2017 is primarily due to the discrete tax impact of the in-process research and development charge attributable to the IntelliMedical acquisition completed in the third quarter of 2017, which is not deductible for tax purposes. Our provision for income taxes for the nine months ended September 30, 2018 and 2017 was a tax expense of approximately $4.5 million and $3.9 million, respectively, which resulted in an effective tax rate of 12.0% and 15.8%, respectively. The decrease in the effective income tax rate for the nine months ended September 30, 2018 compared to the corresponding period of 2017 was primarily due to a discrete tax benefit related to share-based payment awards.

Revolving Credit Facility and Long-Term Debt

9 Months Ended

Sep. 30, 2018

Debt Disclosure [Abstract]

Revolving Credit Facility and Long-Term Debt

Revolving Credit Facility and Long-Term Debt. Principal balances outstanding under our long-term debt obligations as of September 30, 2018 and December 31, 2017, consisted of the following (in thousands):


	September 30, 2018		December 31, 2017
2016 Term loan	$	76,250	$	85,000
2016 Revolving credit loans	126,000		187,000
Collateralized debt facility	7,000		6,959
Less unamortized debt issuance costs	(383)		(487)
Total long-term debt	208,867		278,472
Less current portion	22,000		19,459
Long-term portion	$	186,867	$	259,013

2016 Term Loan and Revolving Credit Loans

On July 6, 2016, we entered into a Second Amended and Restated Credit Agreement (as amended to date, the “Second Amended Credit Agreement”), with Wells Fargo Bank, National Association, as administrative agent, swingline lender and a lender, and Wells Fargo Securities, LLC, as sole lead arranger and sole bookrunner. In addition to Wells Fargo Bank, National Association, Bank of America, N.A., U.S. Bank, National Association, and HSBC Bank USA, National Association, are parties to the Second Amended Credit Agreement as lenders. The Second Amended Credit Agreement amends and restates in its entirety our previously outstanding Amended and Restated Credit Agreement and all amendments thereto. The Second Amended Credit Agreement was amended on September 28, 2016 to allow for a new revolving credit loan to our wholly-owned subsidiary, on March 20, 2017 to allow flexibility in how we apply net proceeds received from equity issuances to prepay outstanding indebtedness, on December 13, 2017 to increase the revolving credit commitment by $100 million up to $375 million, and on March 28, 2018 to amend certain debt covenants.

The Second Amended Credit Agreement provides for a term loan of $150 million and a revolving credit commitment up to an aggregate amount of $375 million, which includes a reserve of $25 million to make swingline loans from time to time. The term loan is payable in quarterly installments in the amounts provided in the Second Amended Credit Agreement until the maturity date of July 6, 2021, at which time the term and revolving credit loans, together with accrued interest thereon, will be due and payable. At any time prior to the maturity date, we may repay any amounts owing under all revolving credit loans, term loans, and all swingline loans in whole or in part, subject to certain minimum thresholds, without premium or penalty, other than breakage costs.

Revolving credit loans denominated in dollars and term loans made under the Second Amended Credit Agreement bear interest, at our election, at either a Base Rate or Eurocurrency Base Rate (as such terms are defined in the Second Amended Credit Agreement) plus the applicable margin, which increases as our Consolidated Total Leverage Ratio (as defined in the Second Amended Credit Agreement) increases. Revolving credit loans denominated in an Alternative Currency (as defined in the Second Amended Credit Agreement) bear interest at the Eurocurrency rate plus the applicable margin. Swingline loans bear interest at the Base Rate plus the applicable margin. Upon an event of default, the interest rate may be increased by 2.0%. The revolving credit commitment also carries a commitment fee of 0.15% to 0.40% per annum on the unused portion.

The Second Amended Credit Agreement is collateralized by substantially all our assets. The Second Amended Credit Agreement contains covenants, representations and warranties, and other terms customary for loans of this nature. The Second Amended Credit Agreement requires that we maintain certain financial covenants, as follows:

Covenant Requirement

Consolidated Total Leverage Ratio ⁽¹⁾

January 1, 2018 and thereafter

3.5 to 1.0

Consolidated EBITDA ⁽²⁾

1.25 to 1.0

Consolidated Net Income ⁽³⁾

Facility Capital Expenditures ⁽⁴⁾

$30 million

⁽¹⁾

Maximum Consolidated Total Leverage Ratio (as defined in the Second Amended Credit Agreement) as of any fiscal quarter end.

⁽²⁾

Minimum ratio of Consolidated EBITDA (as defined in the Second Amended Credit Agreement and adjusted for certain expenditures) to Consolidated Fixed Charges (as defined in the Second Amended Credit Agreement) for any period of four consecutive fiscal quarters.

⁽³⁾

Minimum level of Consolidated Net Income (as defined in the Second Amended Credit Agreement) for certain periods, and subject to certain adjustments.

⁽⁴⁾

Maximum level of the aggregate amount of all Facility Capital Expenditures (as defined in the Second Amended Credit Agreement) in any fiscal year.

Additionally, the Second Amended Credit Agreement contains customary events of default and affirmative and negative covenants for transactions of this type. As of September 30, 2018, we believe we were in compliance with all covenants set forth in the Second Amended Credit Agreement.

As of September 30, 2018, we had outstanding borrowings of approximately $202.3 million under the Second Amended Credit Agreement, with available borrowings of approximately $248.4 million, based on the leverage ratio required pursuant to the Second Amended Credit Agreement. Our interest rate as of September 30, 2018 was a fixed rate of 2.87% on $175.0 million as a result an interest rate swap (see Note 11) and a variable floating rate of 3.99% on $27.3 million. Our interest rate as of December 31, 2017 was a fixed rate of 2.68% on $175 million as a result of an interest rate swap and a variable floating rate of 2.82% on $97 million.

Collateralized Debt Facility

On September 3, 2018, we renewed our loan agreement with HSBC Bank whereby HSBC Bank agreed to provide us with a loan in the amount of approximately $7.0 million. The loan matures on January 10, 2019, with an extension available at our option, subject to certain conditions. The loan agreement bears interest at the six-month London Inter-Bank Offered Rate (“LIBOR”) plus 1.0%. The loan is secured by assets having a value not less than the currently outstanding loan balance. The loan contains covenants, representations and warranties and other terms customary for loans of this nature. As of September 30, 2018, our interest rate on the loan was a variable rate of 3.12%.

Future Payments

Future minimum principal payments on our long-term debt as of September 30, 2018, are as follows (in thousands):


Years Ending	Future Minimum
December 31	Principal Payments
Remaining 2018	$	3,750
2019	22,000
2020	17,500
2021	166,000
Total future minimum principal payments	$	209,250

Derivatives

9 Months Ended

Sep. 30, 2018

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Derivatives

General. Our earnings and cash flows are subject to fluctuations due to changes in interest rates and foreign currency exchange rates, and we seek to mitigate a portion of these risks by entering into derivative contracts. The derivatives we use are interest rate swaps and foreign currency forward contracts. We recognize derivatives as either assets or liabilities at fair value in the accompanying consolidated balance sheets, regardless of whether or not hedge accounting is applied. We report cash flows arising from our hedging instruments consistent with the classification of cash flows from the underlying hedged items. Accordingly, cash flows associated with our derivative programs are classified as operating activities in the accompanying consolidated statements of cash flows.

We formally document, designate and assess the effectiveness of transactions that receive hedge accounting initially and on an ongoing basis. Changes in the fair value of derivatives that qualify for hedge accounting treatment are recorded, net of applicable taxes, in accumulated other comprehensive income (loss), a component of stockholders’ equity in the accompanying consolidated balance sheets. For the ineffective portions of qualifying hedges, the change in fair value is recorded through earnings in the period of change. Changes in the fair value of derivatives not designated as hedging instruments are recorded in earnings throughout the term of the derivative.

Interest Rate Risk. A portion of our debt bears interest at variable interest rates and, therefore, we are subject to variability in the cash paid for interest expense. In order to mitigate a portion of this risk, we use a hedging strategy to reduce the variability of cash flows in the interest payments associated with a portion of the variable-rate debt outstanding under our Second Amended Credit Agreement that is solely due to changes in the benchmark interest rate.

Derivatives Designated as Cash Flow Hedges

On August 5, 2016, we entered into a pay-fixed, receive-variable interest rate swap with a current notional amount of $175.0 million with Wells Fargo to fix the one-month LIBOR rate at 1.12%. The variable portion of the interest rate swap is tied to the one-month LIBOR rate (the benchmark interest rate). On a monthly basis, the interest rates under both the interest rate swap and the underlying debt reset, the swap is settled with the counterparty, and interest is paid. The interest rate swap is scheduled to expire on July 6, 2021.

At September 30, 2018 and December 31, 2017, our interest rate swap qualified as a cash flow hedge. The fair value of our interest rate swap at September 30, 2018 was an asset of approximately $8.3 million, which was partially offset by approximately $2.1 million in deferred taxes. The fair value of our interest rate swap at December 31, 2017 was an asset of approximately $5.7 million, which was offset by approximately $1.5 million in deferred taxes.

Foreign Currency Risk. We operate on a global basis and are exposed to the risk that our financial condition, results of operations, and cash flows could be adversely affected by changes in foreign currency exchange rates. To reduce the potential effects of foreign currency exchange rate movements on net earnings, we enter into derivative financial instruments in the form of foreign currency exchange forward contracts with major financial institutions. Our policy is to enter into foreign currency derivative contracts with maturities of up to two years. We are primarily exposed to foreign currency exchange rate risk with respect to transactions and balances denominated in Euros, British Pounds, Chinese Renminbi, Mexican Pesos, Brazilian Reals, Australian Dollars, Hong Kong Dollars, Swiss Francs, Swedish Krona, Canadian Dollars, Danish Krone, Japanese Yen, Korean Won, and Singapore Dollars. We do not use derivative financial instruments for trading or speculative purposes. We are not subject to any credit risk contingent features related to our derivative contracts, and counterparty risk is managed by allocating derivative contracts among several major financial institutions.

Derivatives Designated as Cash Flow Hedges

For derivative instruments that are designated and qualify as cash flow hedges, the effective portion of the gain or loss on the derivative instrument is reported as a component of other comprehensive income (loss) and reclassified into earnings in the same line item associated with the forecasted transaction and in the same period or periods during which the hedged transaction affects earnings. The remaining gain or loss on the derivative instrument in excess of the cumulative change in the present value of future cash flows of the hedged item, if any (i.e., the ineffective portion) or hedge components excluded from the assessment of effectiveness, are recognized in earnings during the current period. We enter into forward contracts on various foreign currencies to manage the risk associated with forecasted exchange rates which impact revenues, cost of sales, and operating

expenses in various international markets. The objective of the hedges is to reduce the variability of cash flows associated with the forecasted purchase or sale of the associated foreign currencies.

We enter into approximately 150 cash flow foreign currency hedges every month. As of September 30, 2018, we had entered into foreign currency forward contracts, which qualified as cash flow hedges, with the following notional amounts (in thousands and in local currencies):


Currency	Symbol	Forward Notional Amount
Canadian Dollar	CAD	2,460
Swiss Franc	CHF	1,215
Chinese Renminbi	CNY	60,000
Danish Krone	DKK	10,835
Euro	EUR	12,270
British Pound	GBP	3,355
Japanese Yen	JPY	330,000
Mexican Peso	MXN	93,575
Swedish Krona	SEK	12,780

Derivatives Not Designated as Cash Flow Hedges

We forecast our net exposure in various receivables and payables to fluctuations in the value of various currencies, and we enter into foreign currency forward contracts to mitigate that exposure. We enter into approximately 20 foreign currency fair value hedges every month. As of September 30, 2018, we had entered into foreign currency forward contracts related to those balance sheet accounts, with the following notional amounts (in thousands and in local currencies):


Currency	Symbol	Forward Notional Amount
Australian Dollar	AUD	11,150
Brazilian Real	BRL	8,500
Canadian Dollar	CAD	3,098
Swiss Franc	CHF	255
Chinese Renminbi	CNY	95,228
Danish Krone	DKK	2,885
Euro	EUR	25,861
British Pound	GBP	1,584
Hong Kong Dollar	HKD	11,000
Japanese Yen	JPY	260,000
Korean Won	KRW	2,700,000
Mexican Peso	MXN	18,700
Swedish Krona	SEK	10,536
Singapore Dollar	SGD	6,900

Balance Sheet Presentation of Derivatives. As of September 30, 2018, and December 31, 2017, all derivatives, both those designated as hedging instruments and those that were not designated as hedging instruments, were recorded gross at fair value on our consolidated balance sheets. We are not subject to any master netting agreements.

The fair value of derivative instruments on a gross basis is as follows (in thousands):


		Fair Value
	Balance Sheet Location	September 30, 2018		December 31, 2017
Derivatives designated as hedging instruments
Assets
Interest rate swap	Other assets (long-term)	$	8,284	$	5,749
Foreign currency forward contracts	Prepaid expenses and other assets	813		363
Foreign currency forward contracts	Other assets (long-term)	161		35

Liabilities
Foreign currency forward contracts	Accrued expenses	(240)		(468)
Foreign currency forward contracts	Other long-term obligations	(56)		(82)

Derivatives not designated as hedging instruments
Assets
Foreign currency forward contracts	Prepaid expenses and other assets	$	360	$	223
Liabilities
Foreign currency forward contracts	Accrued expenses	(475)		(841)

Income Statement Presentation of Derivatives.

Derivatives Designated as Cash Flow Hedges

Derivative instruments designated as cash flow hedges had the following effects, before income taxes, on other comprehensive income and net earnings in our consolidated statements of income, consolidated statements of comprehensive income and consolidated balance sheets (in thousands):


	Amount of Gain/(Loss) Recognized in OCI							Amount of Gain/(Loss) Reclassified from AOCI
	Three Months Ended September 30,							Three Months Ended September 30,
	2018		2017			2018		2017

Derivative instrument						Location in statements of income
Interest rate swaps	$	664	$	1	Interest Expense	$	428	$	96
Foreign currency forward contracts	543		100		Revenue	86		(101)
					Cost of sales	26		250

	Amount of Gain/(Loss) Recognized in OCI							Amount of Gain/(Loss) Reclassified from AOCI
	Nine Months Ended September 30,							Nine Months Ended September 30,
	2018		2017			2018		2017

Derivative instrument						Location in statements of income
Interest rate swaps	$	3,532	$	(611)	Interest Expense	$	998	$	(8)
Foreign currency forward contracts	1,112		841		Revenue	(299)		(141)
					Cost of sales	404		213

The net amount recognized in earnings during the three and nine months ended September 30, 2018 and 2017 due to ineffectiveness and amounts excluded from the assessment of hedge effectiveness were not significant.

As of September 30, 2018, approximately $858,000, or $637,000 after taxes, was expected to be reclassified from accumulated other comprehensive income to earnings in revenue and cost of sales over the succeeding twelve months. As of September 30, 2018, approximately $2.6 million, or $2.0 million after taxes, was expected to be reclassified from accumulated other comprehensive income to earnings in interest expense over the succeeding twelve months.

Derivatives Not Designated as Hedging Instruments

The following gains/(losses) from these derivative instruments were recognized in our consolidated statements of income for the periods presented (in thousands):


		Three Months Ended September 30,						Nine Months Ended September 30,
		2018		2017		2018		2017
Derivative Instrument	Location in statements of income
Foreign currency forward contracts	Other expense	$	1,143	$	(1,459)	$	3,181	$	(4,150)

Fair Value Measurements

9 Months Ended

Sep. 30, 2018

Fair Value Disclosures [Abstract]

Fair Value Measurements

Fair Value Measurements. Our financial assets and (liabilities) carried at fair value measured on a recurring basis as of September 30, 2018 and December 31, 2017, consisted of the following (in thousands):


			Fair Value Measurements Using
	Total Fair		Quoted prices in		Significant other		Significant
	Value at		active markets		observable inputs		unobservable inputs
Description	September 30, 2018		(Level 1)		(Level 2)		(Level 3)

Interest rate contracts ⁽¹⁾	$	8,284	$	—	$	8,284	$	—
Foreign currency contract assets, current and long-term ⁽²⁾	$	1,334	$	—	$	1,334	$	—
Foreign currency contract liabilities, current and long-term ⁽³⁾	$	(771)	$	—	$	(771)	$	—

			Fair Value Measurements Using
	Total Fair		Quoted prices in		Significant other		Significant
	Value at		active markets		observable inputs		unobservable inputs
Description	December 31, 2017		(Level 1)		(Level 2)		(Level 3)

Interest rate contracts ⁽¹⁾	$	5,749	$	—	$	5,749	$	—
Foreign currency contract assets, current and long-term ⁽²⁾	$	621	$	—	$	621	$	—
Foreign currency contract liabilities, current and long-term ⁽³⁾	$	(1,391)	$	—	$	(1,391)	$	—

(1) The fair value of the interest rate contracts is determined using Level 2 fair value inputs and is recorded as other assets or other long-term obligations in the consolidated balance sheets.

(2) The fair value of the foreign currency contract assets (including those designated as hedging instruments and those not designated as hedging instruments) is determined using Level 2 fair value inputs and is recorded as prepaid expenses and other assets or other long-term assets in the consolidated balance sheets.

(3) The fair value of the foreign currency contract liabilities (including those designated as hedging instruments and those not designated as hedging instruments) is determined using Level 2 fair value inputs and is recorded as accrued expenses or other long-term obligations in the consolidated balance sheets.

Certain of our business combinations involve the potential for the payment of future contingent consideration, generally based on a percentage of future product sales or upon attaining specified future revenue milestones. See Note 5 for further information regarding these acquisitions. The contingent consideration liability is re-measured at the estimated fair value each reporting period with the change in fair value recognized within operating expenses in the accompanying consolidated statements of income. We measure the initial liability and re-measure the liability on a recurring basis using Level 3 inputs as defined under authoritative guidance for fair value measurements. Changes in the fair value of our contingent consideration liability during the three and nine-month periods ended September 30, 2018 and 2017, consisted of the following (in thousands):


	Three Months Ended September 30,						Nine Months Ended September 30,
	2018		2017		2018		2017
Beginning balance	$	10,912	$	5,572	$	10,956	$	683
Contingent consideration liability recorded as the result of acquisitions (see Note 5)	—		5,500		—		10,400
Fair value adjustments recorded to income during the period	(828)		20		(741)		39
Contingent payments made	(53)		(15)		(184)		(45)
Ending balance	$	10,031	$	11,077	$	10,031	$	11,077

As of September 30, 2018, approximately $9.8 million in contingent consideration liability was included in other long-term obligations and approximately $280,000 was included in accrued expenses in our consolidated balance sheet. As of December 31, 2017, approximately $10.7 million in contingent consideration liability was included in other long-term obligations and $289,000 was included in accrued expenses in our consolidated balance sheet. The cash paid to settle the contingent consideration liability recognized at fair value as of the acquisition date (including measurement-period adjustments) has been reflected as a cash outflow from financing activities in the accompanying consolidated statements of cash flows.

During the year ended December 31, 2016, we sold a cost method investment for cash and for the right to receive additional payments based on various contingent milestones. We determined the fair value of the contingent payments using Level 3 inputs defined under authoritative guidance for fair value measurements, and we recorded a contingent receivable asset, which as of September 30, 2018 and December 31, 2017 had a value of approximately $308,000 and $760,000, respectively. We record any changes in fair value to operating expenses as part of our cardiovascular segment in our consolidated statements of income. During the three and nine months ended September 30, 2018, we recorded a loss on the contingent receivable asset of approximately $167,000 and $299,000, respectively and received payments of approximately $0 and $153,000, respectively. As of September 30, 2018, the contingent receivable asset was included in other receivables as a current asset in our consolidated balance sheet. As of December 31, 2017, approximately $319,000 was included in other long-term assets and approximately $441,000 was included in other receivables as a current asset in our consolidated balance sheet.

The recurring Level 3 measurement of our contingent consideration liability and contingent receivable includes the following significant unobservable inputs at September 30, 2018 and December 31, 2017 (amounts in thousands):

Contingent consideration asset or liability

Fair Value at
September 30, 2018

Valuation technique

Unobservable inputs

Range

Revenue-based payments

10,031

Discounted cash flow

Discount rate

9.9% - 15%

contingent liability

Projected year of payments

2018-2037

Contingent receivable

308

Discounted cash flow

Discount rate

10%

asset

Weighted-average probability of milestone payment

35%

Projected year of payments

2018-2019

Contingent consideration asset or liability

Fair Value at December 31, 2017

Valuation technique

Unobservable inputs

Range

Revenue-based payments

10,956

Discounted cash flow

Discount rate

9.9% - 15%

contingent liability

Probability of milestone payment

100%

Projected year of payments

2018-2037

Contingent receivable

760

Discounted cash flow

Discount rate

10%

asset

Weighted-average probability of milestone payment

75%

Projected year of payments

2018-2019

The contingent consideration liability and contingent receivable are re-measured to fair value each reporting period using projected revenues, discount rates, probabilities of payment, and projected payment dates. Projected contingent payment amounts are discounted back to the current period using a discounted cash flow model. Projected revenues are based on our

most recent internal operational budgets and long-range strategic plans. An increase (decrease) in either the discount rate or the time to payment, in isolation, may result in a significantly lower (higher) fair value measurement. A decrease in the probability of any milestone payment may result in lower fair value measurements. Our determination of the fair value of the contingent consideration liability and contingent receivable could change in future periods based upon our ongoing evaluation of these significant unobservable inputs. We intend to record any such change in fair value to operating expenses in our consolidated statements of income.

During the three and nine-month periods ended September 30, 2018, we had losses of approximately $0 and $86,000, respectively, compared to losses of approximately $67,000 and $86,000 for the three and nine-month periods ended September 30, 2017, respectively, related to the measurement of non-financial assets at fair value on a nonrecurring basis subsequent to their initial recognition (see Note 13).

We believe the carrying amount of cash and cash equivalents, receivables, and trade payables approximate fair value because of the immediate, short-term maturity of these financial instruments. Our long-term debt re-prices frequently due to variable rates and entails no significant changes in credit risk and, as a result, we believe the fair value of long-term debt approximates carrying value. The fair value of assets and liabilities whose carrying value approximates fair value is determined using Level 2 inputs, with the exception of cash and cash equivalents, which are Level 1 inputs.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Goodwill and Intangible Assets

9 Months Ended

Sep. 30, 2018

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

Goodwill and Intangible Assets. The changes in the carrying amount of goodwill for the nine-month period ended September 30, 2018 were as follows (in thousands):


	2018
Goodwill balance at January 1	$	238,147
Effect of foreign exchange	(881)

Additions as the result of acquisitions	11,757
Goodwill balance at September 30	$	249,023

As of September 30, 2018, we had recorded $8.3 million of accumulated goodwill impairment charges. All of the goodwill balance as of September 30, 2018 and December 31, 2017, is related to our cardiovascular segment.

Other intangible assets at September 30, 2018 and December 31, 2017, consisted of the following (in thousands):


	September 30, 2018
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Patents	$	18,676	$	(4,665)	$	14,011
Distribution agreements	8,012		(5,509)		2,503
License agreements	24,913		(6,895)		18,018
Trademarks	21,514		(6,039)		15,475
Covenants not to compete	1,028		(993)		35
Customer lists	35,590		(21,987)		13,603
In-process technology	920		—		920

Total	$	110,653	$	(46,088)	$	64,565


	December 31, 2017
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Patents	$	16,528	$	(3,737)	$	12,791
Distribution agreements	7,262		(4,686)		2,576
License agreements	23,783		(5,568)		18,215
Trademarks	16,224		(4,686)		11,538
Covenants not to compete	1,028		(968)		60
Customer lists	31,935		(18,482)		13,453
In-process technology	920		—		920

Total	$	97,680	$	(38,127)	$	59,553

Aggregate amortization expense for the three and nine-month periods ended September 30, 2018 was approximately $10.5 million and $29.4 million, respectively. Aggregate amortization expense for the three and nine-month periods ended September 30, 2017 was approximately $7.0 million and $19.4 million, respectively.

We evaluate long-lived assets, including amortizing intangible assets, for impairment whenever events or changes in circumstances indicate that their carrying amounts may not be recoverable. We perform the impairment analysis at the asset group for which the lowest level of identifiable cash flows are largely independent of the cash flows of other assets and liabilities. During the three months ended September 30, 2018, we compared the carrying value of the amortizing intangible assets acquired in our July 2015 acquisition of certain assets from Quellent, LLC, all of which pertained to our cardiovascular segment, to the undiscounted cash flows expected to result from the asset group and determined that the carrying amount was not recoverable. We then determined the fair value of the amortizing assets related to the Quellent acquisition based on estimated future cash flows discounted back to their present value using a discount rate that reflects the risk profiles of the underlying activities. Some of the factors that influenced our estimated cash flows were slower than anticipated sales growth in the products acquired from our Quellent acquisition and uncertainty about future sales growth. The excess of the carrying value compared to the fair value was recognized as an intangible asset impairment charge. We recorded an impairment charge for Quellent of approximately $657,000. We did not record any impairment charges during the three and nine months ended September 30, 2017.

Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of September 30, 2018 (in thousands):


Year Ending December 31
Remaining 2018	$	10,140
2019	39,647
2020	38,386
2021	31,025
2022	29,141

Commitments and Contingencies	9 Months Ended
Commitments and Contingencies	Sep. 30, 2018
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies. In the ordinary course of business, we are involved in various claims and litigation matters. These claims and litigation matters may include actions involving product liability, intellectual property, contract disputes, and employment or other matters that are significant to our business. Based upon our review of currently available information, we do not believe any such actions are likely to be, individually or in the aggregate, materially adverse to our business, financial condition, results of operations or liquidity.In October 2016, we received a subpoena from the U.S. Department of Justice seeking information on certain of our marketing and promotional practices. We are in the process of responding to the subpoena, which we anticipate will continue during 2018. We have incurred, and anticipate that we will continue to incur, substantial costs in connection with the matter. The investigation is ongoing and at this stage we are unable to predict its scope, duration or outcome. Investigations such as this may result in the imposition of, among other things, significant damages, injunctions, fines or civil or criminal claims or penalties against our company or individuals. Legal expenses we incurred in responding to the U.S. Department of Justice subpoena for the three and nine-month periods ended September 30, 2018 were approximately $946,000 and $4.3 million, respectively.In the event of unexpected further developments, it is possible that the ultimate resolution of any of the foregoing matters, or other similar matters, if resolved in a manner unfavorable to us, may be materially adverse to our business, financial condition, results of operations or liquidity. Legal costs for these matters, such as outside counsel fees and expenses, are charged to expense in the period incurred.

Issuance of Common Stock	9 Months Ended
Issuance of Common Stock	Sep. 30, 2018
Equity [Abstract]
Issuance of Common Stock	Issuance of Common Stock. On July 30, 2018, we closed a public offering of 4,025,000 shares of common stock and received proceeds of approximately $205.4 million, which is net of approximately $12.0 million in underwriting discounts and commissions, and we paid approximately $366,000 in other direct costs incurred in connection with this equity offering. The net proceeds from the offering were used primarily to repay outstanding borrowings (principally revolving credit loans) under our Second Amended Credit Agreement.On March 28, 2017, we closed a public offering of 5,175,000 shares of common stock and received proceeds of approximately $136.6 million, which is net of approximately $8.8 million in underwriting discounts and commissions, and we paid approximately $816,000 in other direct costs incurred in connection with this equity offering. The net proceeds from the offering were used primarily to repay outstanding borrowings (including our term loan and revolving credit loans) under our Second Amended Credit Agreement.

Subsequent Events	9 Months Ended
Subsequent Events	Sep. 30, 2018
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events. On October 1, 2018, we signed a definitive merger agreement (the "Cianna Merger Agreement") to acquire Cianna Medical, Inc. ("Cianna"). The transaction is subject to the satisfaction or waiver (in accordance with the provisions of the Cianna Merger Agreement) of certain closing conditions, including the approval of Cianna stockholders, clearance under the Hart-Scott-Rodino Antitrust Improvements Act and other customary closing conditions. We anticipate that the transaction will close during the fourth quarter of 2018. Subject to the terms and conditions of the Cianna Merger Agreement, we propose to pay up to $200 million in connection with the acquisition of Cianna, as follows: • $135 million in cash at closing, subject to standard adjustments for working capital and other matters; • an earn-out payment of $15 million payable upon the achievement by Cianna of certain manufacturing capacity and manufacturing cost milestones on or before June 30, 2019; and • earn-out payments of up to $50 million in the aggregate, payable at the rate of 175% of the amount which annual net sales of Cianna products in each of 2019, 2020, 2021 and 2022 exceed annual net sales of Cianna products in the applicable preceding fiscal year. Cianna claims to have developed the first non-radioactive, wire-free breast localization system. Its SCOUT® and SAVI® Brachy technologies are FDA-cleared and address what we believe are unmet needs in the delivery of radiation therapy, tumor localization and surgical guidance. We are currently evaluating the accounting treatment of the proposed transaction contemplated by the Cianna Merger Agreement.

Basis of Presentation (Policies)	9 Months Ended
Basis of Presentation (Policies)	Sep. 30, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Principles of Consolidation	The interim consolidated financial statements of Merit Medical Systems, Inc. ("Merit," "we" or "us") for the three and nine-month periods ended September 30, 2018 and 2017 are not audited. Our consolidated financial statements are prepared in accordance with the requirements for unaudited interim periods and, consequently, do not include all disclosures required to be made in conformity with accounting principles generally accepted in the United States of America. In the opinion of our management, the accompanying consolidated financial statements contain all adjustments, consisting of normal recurring accruals, necessary for a fair presentation of our financial position as of September 30, 2018 and December 31, 2017, and our results of operations and cash flows for the three and nine-month periods ended September 30, 2018 and 2017. The results of operations for the three and nine-month periods ended September 30, 2018 and 2017 are not necessarily indicative of the results for a full-year period. These interim consolidated financial statements should be read in conjunction with the financial statements included in our Annual Report on Form 10-K (the "2017 Form 10-K") for the year ended December 31, 2017, which was filed with the Securities and Exchange Commission (the "SEC") on March 1, 2018.
Revenue from Contracts with Customers	Revenue from Contracts with Customers. We sell our medical products through a direct sales force in the U.S. and through OEM relationships, custom procedure tray manufacturers and a combination of direct sales force and independent distributors in international markets. Revenue is recognized when a customer obtains control of promised goods based on the consideration we expect to receive in exchange for these goods. This core principle is achieved through the following steps: Identify the contract with the customer. A contract with a customer exists when (i) we enter into an enforceable contract with a customer that defines each party’s rights regarding the goods to be transferred and identifies the payment terms related to these goods, (ii) the contract has commercial substance and, (iii) we determine that collection of substantially all consideration for services that are transferred is probable based on the customer’s intent and ability to pay the promised consideration. We do not have significant costs to obtain contracts with customers. For commissions on product sales, we have elected the practical expedient to expense the costs as incurred if the amortization period would have been one year or less. Identify the performance obligations in the contract. Generally, our contracts with customers do not include multiple performance obligations to be completed over a period of time. Our performance obligations generally relate to delivering single-use medical products to a customer, subject to the shipping terms of the contract. Limited warranties are provided, under which we typically accept returns and provide either replacement parts or refunds. We do not have significant returns. We do not typically offer extended warranty or service plans. Determine the transaction price. Payment by the customer is due under customary fixed payment terms, and we evaluate if collectability is reasonably assured. None of our contracts as of September 30, 2018 contained a significant financing component. Revenue is recorded at the net sales price, which includes estimates of variable consideration such as product returns, rebates, discounts, and other adjustments. The estimates of variable consideration are based on historical payment experience, historical and projected sales data, and current contract terms. Variable consideration is included in revenue only to the extent that it is probable that a significant reversal of the revenue recognized will not occur when the uncertainty associated with the variable consideration is subsequently resolved. Taxes collected from customers relating to product sales and remitted to governmental authorities are excluded from revenues. Allocate the transaction price to performance obligations in the contract. We typically do not have multiple performance obligations in our contracts with customers. As such, we recognize revenue upon transfer of the product to the customer's control at contractually stated pricing. Recognize revenue when or as we satisfy a performance obligation. We satisfy performance obligations at a point in time upon either shipment or delivery of goods, in accordance with the terms of each contract with the customer. We do not have significant service revenue.
Recently Issued Financial Accounting Standards	Recently Issued Financial Accounting Standards Recently Adopted In October 2016, the Financial Accounting Standards Board (the "FASB") issued Accounting Standards Update ("ASU") No. 2016-16, Income Taxes (Topic 740): Intra-Entity Transfers of Assets Other than Inventory, which requires the recognition of the income tax consequences of an intra-entity transfer of an asset, other than inventory, when the transfer occurs. ASU 2016-16 became effective for us as of January 1, 2018. The adoption of ASU 2016-16 did not have a material impact on our consolidated financial statements. In August 2016, the FASB issued ASU No. 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments, which addresses eight specific cash flow issues with the objective of reducing the existing diversity in practice in how certain cash receipts and cash payments are presented and classified in the statement of cash flows. We adopted ASU 2016-15 on January 1, 2018. The adoption of ASU 2016-15 did not have a material impact on our consolidated financial statements. In January 2016, the FASB issued ASU No. 2016-01, Financial Instruments - Overall: Recognition and Measurement of Financial Assets and Financial Liabilities, which amends the guidance regarding the classification and measurement of financial instruments. Changes to the current guidance primarily affect the accounting for equity investments, financial liabilities under the fair value option, and the presentation and disclosure requirements for financial instruments. In addition, ASU 2016-01 clarifies guidance related to the valuation allowance assessment when recognizing deferred tax assets resulting from unrealized losses on available-for-sale debt securities. We adopted ASU 2016-01 on January 1, 2018. The adoption of ASU 2016-01 did not have a material impact on our consolidated financial statements. In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606), which provides a single comprehensive model for entities to use in accounting for revenue arising from contracts with customers. We adopted this ASU (and all subsequent ASUs that modified Topic 606) effective January 1, 2018 on a modified retrospective basis. Adoption of this standard did not result in significant changes to our accounting policies, business processes, systems or controls, or have a material impact on our financial position, results of operations or cash flows. As such, prior period amounts are not adjusted and continue to be reported under accounting standards then in effect, and we did not record a cumulative adjustment to the opening equity balance of retained earnings as of January 1, 2018. However, additional disclosures have been added in accordance with the requirements of Topic 606 and are reflected in Note 6. Not Yet Adopted In August 2018, the FASB issued ASU 2018-15, Intangibles-Goodwill and Other-Internal-Use Software (Subtopic 350-40). The new guidance reduces complexity for the accounting for costs of implementing a cloud computing service arrangement and aligns the requirements for capitalizing implementation costs incurred in a hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain internal-use software (and hosting arrangements that include an internal use software license). ASU 2018-15 is effective for fiscal years beginning after December 15, 2019, and interim periods within those fiscal years, with early adoption permitted. Implementation may be applied either retrospectively or prospectively to all implementation costs incurred after the date of adoption. We are currently evaluating the anticipated impact of adopting ASU 2018-15 on our consolidated financial statements. In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820)—Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurement, which modifies disclosure requirements related to fair value measurements. The amendments in this ASU are effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. Implementation on a prospective or retrospective basis varies by specific disclosure requirement. The standard allows for early adoption of any removed or modified disclosures upon issuance of this ASU while delaying adoption of the additional disclosures until their effective date. We are currently evaluating the anticipated impact of adopting ASU 2018-13 on our consolidated financial statements. In June 2018, the FASB issued ASU 2018-07, Compensation-Stock Compensation (Topic 718): Improvements to Nonemployee Share-Based Payment Accounting, which simplifies the accounting for nonemployee share-based payment transactions by expanding the scope of ASC Topic 718, Compensation - Stock Compensation, to include share-based payment transactions for acquiring goods and services from nonemployees. Under the new standard, most of the guidance on stock compensation payments to nonemployees would be aligned with the requirements for share-based payments granted to employees. This standard is effective for annual reporting periods beginning after December 15, 2018, and interim periods within those fiscal years, with early adoption permitted. While we continue to assess the potential impact of this standard, we do not expect the adoption of this standard to have a material impact on our consolidated financial statements. In February 2018, the FASB issued ASU 2018-02, Income Statement-Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income, which allows a reclassification from accumulated other comprehensive income to retained earnings for stranded tax effects resulting from U.S. federal tax legislation commonly referred to as the Tax Cuts and Jobs Act, which was enacted in December 2017 (the "2017 Tax Act"). ASU 2018-02 is effective for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years. Early adoption is permitted. While we continue to assess our adoption policy for this standard, we do not expect adoption to have a material impact on our consolidated financial statements. In August 2017, the FASB issued ASU 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities, which expands and refines hedge accounting for both financial and non-financial risk components, aligns the recognition and presentation of the effects of hedging instruments and hedge items in the financial statements, and includes certain targeted improvements to ease the application of current guidance related to the assessment of hedge effectiveness. ASU 2017-12 is effective for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years. Early adoption is permitted. We are currently evaluating the anticipated impact of adopting ASU 2017-12 on our consolidated financial statements. In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842), which eliminates the current tests for lease classification under U.S. GAAP and requires lessees to recognize the right-of-use assets and related lease liabilities on the balance sheet for all leases greater than one year in duration. ASU 2016-02 is effective for fiscal years beginning after December 15, 2018, including interim periods within those fiscal years. Early adoption of ASU 2016-02 is permitted. In July 2018, the FASB issued ASU 2018-11 to provide a transition practical expedient by allowing entities to initially apply the new leases standard at the adoption date, recognize a cumulative-effect adjustment to the opening balance of retained earnings in the period of adoption, and not restate prior periods. We expect to adopt this as well as certain other practical expedients available to us under the new guidance. We have implemented processes and information technology tools to assist in our ongoing lease data collection and analysis. We are currently finalizing our lease portfolio analysis to determine the impact to our consolidated financial statements, and currently expect that most of our operating lease commitments will be recognized as lease liabilities and right-of-use assets upon our adoption of ASU 2016-02. We are updating our accounting policies and internal controls that will be impacted by the new guidance to ensure readiness for adoption in the first quarter of 2019. We do not believe any other issued and not yet effective accounting standards will be relevant to our consolidated financial statements.
Derivatives	Derivatives General. Our earnings and cash flows are subject to fluctuations due to changes in interest rates and foreign currency exchange rates, and we seek to mitigate a portion of these risks by entering into derivative contracts. The derivatives we use are interest rate swaps and foreign currency forward contracts. We recognize derivatives as either assets or liabilities at fair value in the accompanying consolidated balance sheets, regardless of whether or not hedge accounting is applied. We report cash flows arising from our hedging instruments consistent with the classification of cash flows from the underlying hedged items. Accordingly, cash flows associated with our derivative programs are classified as operating activities in the accompanying consolidated statements of cash flows. We formally document, designate and assess the effectiveness of transactions that receive hedge accounting initially and on an ongoing basis. Changes in the fair value of derivatives that qualify for hedge accounting treatment are recorded, net of applicable taxes, in accumulated other comprehensive income (loss), a component of stockholders’ equity in the accompanying consolidated balance sheets. For the ineffective portions of qualifying hedges, the change in fair value is recorded through earnings in the period of change. Changes in the fair value of derivatives not designated as hedging instruments are recorded in earnings throughout the term of the derivative. Interest Rate Risk. A portion of our debt bears interest at variable interest rates and, therefore, we are subject to variability in the cash paid for interest expense. In order to mitigate a portion of this risk, we use a hedging strategy to reduce the variability of cash flows in the interest payments associated with a portion of the variable-rate debt outstanding under our Second Amended Credit Agreement that is solely due to changes in the benchmark interest rate. Derivatives Designated as Cash Flow Hedges On August 5, 2016, we entered into a pay-fixed, receive-variable interest rate swap with a current notional amount of $175.0 million with Wells Fargo to fix the one-month LIBOR rate at 1.12%. The variable portion of the interest rate swap is tied to the one-month LIBOR rate (the benchmark interest rate). On a monthly basis, the interest rates under both the interest rate swap and the underlying debt reset, the swap is settled with the counterparty, and interest is paid. The interest rate swap is scheduled to expire on July 6, 2021. At September 30, 2018 and December 31, 2017, our interest rate swap qualified as a cash flow hedge. The fair value of our interest rate swap at September 30, 2018 was an asset of approximately $8.3 million, which was partially offset by approximately $2.1 million in deferred taxes. The fair value of our interest rate swap at December 31, 2017 was an asset of approximately $5.7 million, which was offset by approximately $1.5 million in deferred taxes. Foreign Currency Risk. We operate on a global basis and are exposed to the risk that our financial condition, results of operations, and cash flows could be adversely affected by changes in foreign currency exchange rates. To reduce the potential effects of foreign currency exchange rate movements on net earnings, we enter into derivative financial instruments in the form of foreign currency exchange forward contracts with major financial institutions. Our policy is to enter into foreign currency derivative contracts with maturities of up to two years. We are primarily exposed to foreign currency exchange rate risk with respect to transactions and balances denominated in Euros, British Pounds, Chinese Renminbi, Mexican Pesos, Brazilian Reals, Australian Dollars, Hong Kong Dollars, Swiss Francs, Swedish Krona, Canadian Dollars, Danish Krone, Japanese Yen, Korean Won, and Singapore Dollars. We do not use derivative financial instruments for trading or speculative purposes. We are not subject to any credit risk contingent features related to our derivative contracts, and counterparty risk is managed by allocating derivative contracts among several major financial institutions. Derivatives Designated as Cash Flow Hedges For derivative instruments that are designated and qualify as cash flow hedges, the effective portion of the gain or loss on the derivative instrument is reported as a component of other comprehensive income (loss) and reclassified into earnings in the same line item associated with the forecasted transaction and in the same period or periods during which the hedged transaction affects earnings. The remaining gain or loss on the derivative instrument in excess of the cumulative change in the present value of future cash flows of the hedged item, if any (i.e., the ineffective portion) or hedge components excluded from the assessment of effectiveness, are recognized in earnings during the current period. We enter into forward contracts on various foreign currencies to manage the risk associated with forecasted exchange rates which impact revenues, cost of sales, and operating expenses in various international markets. The objective of the hedges is to reduce the variability of cash flows associated with the forecasted purchase or sale of the associated foreign currencies.

Inventories (Tables)

9 Months Ended

Sep. 30, 2018

Inventory Disclosure [Abstract]

Schedule of Inventory

Inventories at September 30, 2018 and December 31, 2017, consisted of the following (in thousands):


	September 30,		December 31,
	2018		2017
Finished goods	$	103,258	$	86,555
Work-in-process	20,546		12,799
Raw materials	57,635		55,934

Total Inventories	$	181,439	$	155,288

Stock-Based Compensation Expense (Tables)

9 Months Ended

Sep. 30, 2018

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Schedule of Employee Service Share-based Compensation, Allocation of Recognized Period Costs

Stock-based compensation expense before income tax expense for the three and nine months ended September 30, 2018 and 2017, consisted of the following (in thousands):


	Three Months Ended September 30,						Nine Months Ended September 30,
	2018		2017		2018		2017
Cost of sales	$	241	$	189	$	657	$	453
Research and development	141		110		412		262
Selling, general and administrative	1,291		893		3,425		2,168
Stock-based compensation expense before taxes	$	1,673	$	1,192	$	4,494	$	2,883

Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions

In applying the Black-Scholes methodology to the option grants, the fair value of our stock-based awards granted was estimated using the following assumptions for the periods indicated below:


	Nine Months Ended September 30,
	2018	2017
Risk-free interest rate	2.63% - 2.77%	1.77% - 1.83%
Expected option life	5.0 years	5.0 years
Expected dividend yield	—	—
Expected price volatility	34.06% - 34.32%	33.81% - 34.07%

Earnings Per Common Share (EPS) (Tables)

9 Months Ended

Sep. 30, 2018

Earnings Per Share, Basic and Diluted [Abstract]

Schedule of Earnings Per Share, Basic and Diluted

The computation of weighted average shares outstanding and the basic and diluted earnings per common share for the following periods consisted of the following (in thousands, except per share amounts):


	Three Months								Nine Months
	Net Income		Shares	Per Share Amount		Net Income		Shares	Per Share Amount
Period ended September 30, 2018:
Basic EPS	$	16,619	53,431	$	0.31	$	32,828	51,434	$	0.64
Effect of dilutive stock options and warrants			1,672					1,662

Diluted EPS	$	16,619	55,103	$	0.30	$	32,828	53,096	$	0.62

Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive			667					462

Period ended September 30, 2017:
Basic EPS	$	(3,569)	50,150	$	(0.07)	$	20,717	48,332	$	0.43
Effect of dilutive stock options and warrants			1,449					1,223

Diluted EPS	$	(3,569)	51,599	$	(0.07)	$	20,717	49,555	$	0.42

Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive			200					434

Acquisitions (Tables)

9 Months Ended

Sep. 30, 2018

Business Acquisition [Line Items]

Business Acquisition, Pro Forma Information


	Nine Months Ended
	September 30, 2017
	As Reported		Pro Forma
Net sales	$	536,955	$	539,715
Net income	20,717		10,039
Earnings per common share:
Basic	$	0.43	$	0.21
Diluted	$	0.42	$	0.20

DirectACCESS Medical, LLC

Business Acquisition [Line Items]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

The purchase price was preliminarily allocated as follows (in thousands):


Inventories	$	971
Intangibles
Developed technology	4,840
Customer list	120
Trademarks	400
Goodwill	938

Total assets acquired	$	7,269

Becton, Dickinson and Company

Business Acquisition [Line Items]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

The following table summarizes the purchase price allocated to the assets acquired from BD (in thousands):


Inventories	$	5,804
Property and equipment	748
Intangibles
Developed technology	74,000
Customer list	4,200
Trademarks	4,900
Goodwill	10,613

Total assets acquired	$	100,265

ITL Healthcare Pty Ltd

Business Acquisition [Line Items]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

The following table summarizes the aggregate purchase price allocated to the assets acquired from ITL (in thousands):


Assets Acquired
Trade receivables	$	1,287
Other receivables	56
Inventories	1,808
Prepaid expenses and other assets	65
Property and equipment	1,053
Intangibles
Customer lists	5,940
Goodwill	3,945
Total assets acquired	14,154

Liabilities Assumed
Trade payables	(216)
Accrued expenses	(747)
Deferred income tax liabilities	(1,901)
Total liabilities assumed	(2,864)

Total net assets acquired	$	11,290

Laurane Medical S.A.S.

Business Acquisition [Line Items]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

The following table summarizes the aggregate purchase price (including contingent royalty payment liabilities) allocated to the assets acquired from Laurane (in thousands):


Inventories	$	594
Intangibles
Developed technology	14,920
Customer list	120
Goodwill	6,366

Total assets acquired	$	22,000

Osseon LLC

Business Acquisition [Line Items]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

The following table summarizes the purchase price allocated to the assets acquired (in thousands):


Inventories	$	979
Property and equipment	58
Intangibles
Developed technology	5,400
Customer list	200
Goodwill	203

Total assets acquired	$	6,840

Vascular Access Technologies, Inc.

Business Acquisition [Line Items]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

The following table summarizes the purchase price allocated to the net assets acquired (in thousands):


Intangibles
Developed technology	$	7,800
In-process technology	920
Goodwill	4,281
Deferred tax liabilities	(3,101)

Total net assets acquired	$	9,900

Argon Medical Devices, Inc.

Business Acquisition [Line Items]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

The following table summarizes the purchase price allocated to the net tangible and intangible assets acquired and liabilities assumed (in thousands):


	Assets Acquired
	Cash and cash equivalents	$	1,436
	Trade receivables	8,351
	Inventories	11,222
	Prepaid expenses and other assets	1,275
	Income tax refund receivables	165
	Property and equipment	2,319
	Deferred income tax assets	202
	Intangibles
	Developed technology	2,200
	Customer lists	1,500
	Trademarks	900
	Total assets acquired	29,570

	Liabilities Assumed
	Trade payables	(2,414)
	Accrued expenses	(5,083)
	Deferred income tax liabilities	(934)
	Total liabilities assumed	(8,431)

	Total net assets acquired	21,139
	Gain on bargain purchase ⁽¹⁾	(11,039)
	Total purchase price	$	10,100

⁽¹⁾	The total fair value of the net assets acquired from Argon exceeded the purchase price, resulting in a gain on bargain purchase which was recorded within other income (expense) in our consolidated statements of income. We believe the reason for the gain on bargain purchase was a result of the divestiture of a non-strategic, slow-growth critical care business for Argon. It is our understanding that the divestiture allows Argon to focus on its higher growth interventional portfolio. A reduction of $1.2 million was recorded since the bargain purchase gain was first presented in our Quarterly Report on Form 10-Q for the quarter ended March 31, 2017, resulting from our ongoing activities, including reassessment of the assets acquired and liabilities assumed. The purchase price allocation for this acquisition is now final.

Catheter Connections, Inc.

Business Acquisition [Line Items]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed

The purchase price was allocated as follows (in thousands):


Assets Acquired
Trade receivables	$	958
Inventories	2,157
Prepaid expenses and other assets	85
Property and equipment	1,472
Intangibles
Developed technology	21,100
Customer lists	700
Trademarks	2,900
Goodwill	8,989
Total assets acquired	38,361

Liabilities Assumed
Trade payables	(338)
Accrued expenses	(23)
Total liabilities assumed	(361)

Total net assets acquired	$	38,000

Revenue from Contracts with Customers (Tables)

9 Months Ended

Sep. 30, 2018

Revenue from Contract with Customer [Abstract]

Schedule of Disaggregation of Revenue

The following tables present revenue from contracts with customers for the three and nine-month periods ended September 30, 2018 and 2017 (in thousands):


	Three Months Ended September 30, 2018										Three Months Ended September 30, 2017
	United States		International		Total		United States		International		Total
Cardiovascular
Stand-alone devices	$	52,173	$	38,802	$	90,975	$	36,383	$	32,366	$	68,749
Custom kits and procedure trays	23,199		9,896		33,095		23,085		7,326		30,411
Inflation devices	7,819		15,074		22,893		8,241		11,792		20,033
Catheters	18,081		22,510		40,591		15,377		16,374		31,751
Embolization devices	5,145		7,250		12,395		5,414		6,838		12,252
CRM/EP	10,462		1,739		12,201		8,202		1,325		9,527
Total	116,879		95,271		212,150		96,702		76,021		172,723

Endoscopy
Endoscopy devices	9,229		280		9,509		6,389		225		6,614

Total	$	126,108	$	95,551	$	221,659	$	103,091	$	76,246	$	179,337


	Nine Months Ended September 30, 2018										Nine Months Ended September 30, 2017
	United States		International		Total		United States		International		Total
Cardiovascular
Stand-alone devices	$	147,125	$	119,592	$	266,717	$	109,750	$	93,709	$	203,459
Custom kits and procedure trays	69,184		31,175		100,359		68,823		22,259		91,082
Inflation devices	23,647		45,970		69,617		24,257		35,072		59,329
Catheters	50,055		63,775		113,830		46,529		47,828		94,357
Embolization devices	15,272		22,434		37,706		16,548		20,388		36,936
CRM/EP	31,058		5,105		36,163		28,212		3,765		31,977
Total	336,341		288,051		624,392		294,119		223,021		517,140

Endoscopy
Endoscopy devices	24,269		843		25,112		19,195		620		19,815

Total	$	360,610	$	288,894	$	649,504	$	313,314	$	223,641	$	536,955

Segment Reporting (Tables)

9 Months Ended

Sep. 30, 2018

Segment Reporting [Abstract]

Schedule of Segment Reporting Information, by Segment

Financial information relating to our reportable operating segments and reconciliations to the consolidated totals for the three and nine-month periods ended September 30, 2018 and 2017, are as follows (in thousands):


	Three Months Ended September 30,						Nine Months Ended September 30,
	2018		2017		2018		2017
Net Sales
Cardiovascular	$	212,150	$	172,723	$	624,392	$	517,140
Endoscopy	9,509		6,614		25,112		19,815
Total net sales	$	221,659	$	179,337	$	649,504	$	536,955

Operating Income (Loss)
Cardiovascular	$	18,199	$	(1,207)	$	37,263	$	14,239
Endoscopy	2,862		2,086		7,692		5,611
Total operating income	$	21,061	$	879	$	44,955	$	19,850

Revolving Credit Facility and Long-Term Debt (Tables)

9 Months Ended

Sep. 30, 2018

Debt Disclosure [Abstract]

Schedule of Long-term Debt Instruments

Principal balances outstanding under our long-term debt obligations as of September 30, 2018 and December 31, 2017, consisted of the following (in thousands):


	September 30, 2018		December 31, 2017
2016 Term loan	$	76,250	$	85,000
2016 Revolving credit loans	126,000		187,000
Collateralized debt facility	7,000		6,959
Less unamortized debt issuance costs	(383)		(487)
Total long-term debt	208,867		278,472
Less current portion	22,000		19,459
Long-term portion	$	186,867	$	259,013

Schedule of Long-term Debt Covenants

The Second Amended Credit Agreement requires that we maintain certain financial covenants, as follows:

Covenant Requirement

Consolidated Total Leverage Ratio ⁽¹⁾

January 1, 2018 and thereafter

3.5 to 1.0

Consolidated EBITDA ⁽²⁾

1.25 to 1.0

Consolidated Net Income ⁽³⁾

Facility Capital Expenditures ⁽⁴⁾

$30 million

⁽¹⁾

Maximum Consolidated Total Leverage Ratio (as defined in the Second Amended Credit Agreement) as of any fiscal quarter end.

⁽²⁾

⁽³⁾

Minimum level of Consolidated Net Income (as defined in the Second Amended Credit Agreement) for certain periods, and subject to certain adjustments.

⁽⁴⁾

Maximum level of the aggregate amount of all Facility Capital Expenditures (as defined in the Second Amended Credit Agreement) in any fiscal year.

Schedule of Maturities of Long-term Debt

Future minimum principal payments on our long-term debt as of September 30, 2018, are as follows (in thousands):


Years Ending	Future Minimum
December 31	Principal Payments
Remaining 2018	$	3,750
2019	22,000
2020	17,500
2021	166,000
Total future minimum principal payments	$	209,250

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

+ References

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Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
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+ Details

Derivatives (Tables)

9 Months Ended

Sep. 30, 2018

Derivative [Line Items]

Schedule of Derivative Instruments in Statement of Financial Position, Fair Value

The fair value of derivative instruments on a gross basis is as follows (in thousands):


		Fair Value
	Balance Sheet Location	September 30, 2018		December 31, 2017
Derivatives designated as hedging instruments
Assets
Interest rate swap	Other assets (long-term)	$	8,284	$	5,749
Foreign currency forward contracts	Prepaid expenses and other assets	813		363
Foreign currency forward contracts	Other assets (long-term)	161		35

Liabilities
Foreign currency forward contracts	Accrued expenses	(240)		(468)
Foreign currency forward contracts	Other long-term obligations	(56)		(82)

Derivatives not designated as hedging instruments
Assets
Foreign currency forward contracts	Prepaid expenses and other assets	$	360	$	223
Liabilities
Foreign currency forward contracts	Accrued expenses	(475)		(841)

Schedule of Cash Flow Hedges Included in Accumulated Other Comprehensive Income (Loss)


	Amount of Gain/(Loss) Recognized in OCI							Amount of Gain/(Loss) Reclassified from AOCI
	Three Months Ended September 30,							Three Months Ended September 30,
	2018		2017			2018		2017

Derivative instrument						Location in statements of income
Interest rate swaps	$	664	$	1	Interest Expense	$	428	$	96
Foreign currency forward contracts	543		100		Revenue	86		(101)
					Cost of sales	26		250

	Amount of Gain/(Loss) Recognized in OCI							Amount of Gain/(Loss) Reclassified from AOCI
	Nine Months Ended September 30,							Nine Months Ended September 30,
	2018		2017			2018		2017

Derivative instrument						Location in statements of income
Interest rate swaps	$	3,532	$	(611)	Interest Expense	$	998	$	(8)
Foreign currency forward contracts	1,112		841		Revenue	(299)		(141)
					Cost of sales	404		213

Derivative Instruments, Gain (Loss)

The following gains/(losses) from these derivative instruments were recognized in our consolidated statements of income for the periods presented (in thousands):


		Three Months Ended September 30,						Nine Months Ended September 30,
		2018		2017		2018		2017
Derivative Instrument	Location in statements of income
Foreign currency forward contracts	Other expense	$	1,143	$	(1,459)	$	3,181	$	(4,150)

Designated as hedging instrument

Derivative [Line Items]

Schedule of Notional Amounts of Outstanding Derivative Positions


Currency	Symbol	Forward Notional Amount
Canadian Dollar	CAD	2,460
Swiss Franc	CHF	1,215
Chinese Renminbi	CNY	60,000
Danish Krone	DKK	10,835
Euro	EUR	12,270
British Pound	GBP	3,355
Japanese Yen	JPY	330,000
Mexican Peso	MXN	93,575
Swedish Krona	SEK	12,780

Not designated as hedging instrument

Derivative [Line Items]

Schedule of Notional Amounts of Outstanding Derivative Positions

As of September 30, 2018, we had entered into foreign currency forward contracts related to those balance sheet accounts, with the following notional amounts (in thousands and in local currencies):


Currency	Symbol	Forward Notional Amount
Australian Dollar	AUD	11,150
Brazilian Real	BRL	8,500
Canadian Dollar	CAD	3,098
Swiss Franc	CHF	255
Chinese Renminbi	CNY	95,228
Danish Krone	DKK	2,885
Euro	EUR	25,861
British Pound	GBP	1,584
Hong Kong Dollar	HKD	11,000
Japanese Yen	JPY	260,000
Korean Won	KRW	2,700,000
Mexican Peso	MXN	18,700
Swedish Krona	SEK	10,536
Singapore Dollar	SGD	6,900

Fair Value Measurements (Tables)

9 Months Ended

Sep. 30, 2018

Fair Value Disclosures [Abstract]

Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis

Our financial assets and (liabilities) carried at fair value measured on a recurring basis as of September 30, 2018 and December 31, 2017, consisted of the following (in thousands):


			Fair Value Measurements Using
	Total Fair		Quoted prices in		Significant other		Significant
	Value at		active markets		observable inputs		unobservable inputs
Description	September 30, 2018		(Level 1)		(Level 2)		(Level 3)

Interest rate contracts ⁽¹⁾	$	8,284	$	—	$	8,284	$	—
Foreign currency contract assets, current and long-term ⁽²⁾	$	1,334	$	—	$	1,334	$	—
Foreign currency contract liabilities, current and long-term ⁽³⁾	$	(771)	$	—	$	(771)	$	—

			Fair Value Measurements Using
	Total Fair		Quoted prices in		Significant other		Significant
	Value at		active markets		observable inputs		unobservable inputs
Description	December 31, 2017		(Level 1)		(Level 2)		(Level 3)

Interest rate contracts ⁽¹⁾	$	5,749	$	—	$	5,749	$	—
Foreign currency contract assets, current and long-term ⁽²⁾	$	621	$	—	$	621	$	—
Foreign currency contract liabilities, current and long-term ⁽³⁾	$	(1,391)	$	—	$	(1,391)	$	—

(1) The fair value of the interest rate contracts is determined using Level 2 fair value inputs and is recorded as other assets or other long-term obligations in the consolidated balance sheets.

Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation

Changes in the fair value of our contingent consideration liability during the three and nine-month periods ended September 30, 2018 and 2017, consisted of the following (in thousands):


	Three Months Ended September 30,						Nine Months Ended September 30,
	2018		2017		2018		2017
Beginning balance	$	10,912	$	5,572	$	10,956	$	683
Contingent consideration liability recorded as the result of acquisitions (see Note 5)	—		5,500		—		10,400
Fair value adjustments recorded to income during the period	(828)		20		(741)		39
Contingent payments made	(53)		(15)		(184)		(45)
Ending balance	$	10,031	$	11,077	$	10,031	$	11,077

Fair Value Inputs, Liabilities, Quantitative Information

Contingent consideration asset or liability

Fair Value at
September 30, 2018

Valuation technique

Unobservable inputs

Range

Revenue-based payments

10,031

Discounted cash flow

Discount rate

9.9% - 15%

contingent liability

Projected year of payments

2018-2037

Contingent receivable

308

Discounted cash flow

Discount rate

10%

asset

Weighted-average probability of milestone payment

35%

Projected year of payments

2018-2019

Contingent consideration asset or liability

Fair Value at December 31, 2017

Valuation technique

Unobservable inputs

Range

Revenue-based payments

10,956

Discounted cash flow

Discount rate

9.9% - 15%

contingent liability

Probability of milestone payment

100%

Projected year of payments

2018-2037

Contingent receivable

760

Discounted cash flow

Discount rate

10%

asset

Weighted-average probability of milestone payment

75%

Projected year of payments

2018-2019

Goodwill and Intangible Assets (Tables)

9 Months Ended

Sep. 30, 2018

Goodwill and Intangible Assets Disclosure [Abstract]

Changes in carrying amount of goodwill

The changes in the carrying amount of goodwill for the nine-month period ended September 30, 2018 were as follows (in thousands):


	2018
Goodwill balance at January 1	$	238,147
Effect of foreign exchange	(881)

Additions as the result of acquisitions	11,757
Goodwill balance at September 30	$	249,023

Other intangible assets

Other intangible assets at September 30, 2018 and December 31, 2017, consisted of the following (in thousands):


	September 30, 2018
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Patents	$	18,676	$	(4,665)	$	14,011
Distribution agreements	8,012		(5,509)		2,503
License agreements	24,913		(6,895)		18,018
Trademarks	21,514		(6,039)		15,475
Covenants not to compete	1,028		(993)		35
Customer lists	35,590		(21,987)		13,603
In-process technology	920		—		920

Total	$	110,653	$	(46,088)	$	64,565


	December 31, 2017
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Patents	$	16,528	$	(3,737)	$	12,791
Distribution agreements	7,262		(4,686)		2,576
License agreements	23,783		(5,568)		18,215
Trademarks	16,224		(4,686)		11,538
Covenants not to compete	1,028		(968)		60
Customer lists	31,935		(18,482)		13,453
In-process technology	920		—		920

Total	$	97,680	$	(38,127)	$	59,553

Estimated amortization expense

Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of September 30, 2018 (in thousands):


Year Ending December 31
Remaining 2018	$	10,140
2019	39,647
2020	38,386
2021	31,025
2022	29,141

Inventories (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Inventory Disclosure [Abstract]
Finished goods	$ 103,258	$ 86,555
Work-in-process	20,546	12,799
Raw materials	57,635	55,934
Total Inventories	$ 181,439	$ 155,288

Stock-Based Compensation Expense - Allocation of Recognized Period Costs (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Stock-based compensation expense before taxes	$ 1,673	$ 1,192	$ 4,494	$ 2,883
Cost of sales
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Stock-based compensation expense before taxes	241	189	657	453
Research and development
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Stock-based compensation expense before taxes	141	110	412	262
Selling, general and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Stock-based compensation expense before taxes	$ 1,291	$ 893	$ 3,425	$ 2,168

Stock-Based Compensation Expense - Narrative (Details) - USD ($) $ in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Compensation cost not yet recognized		$ 20.7
Compensation cost not yet recognized, period of recognition		3 years 3 months
Options granted in period (in shares)	20,000,000	692,002	1,300,000

Stock-Based Compensation Expense - Fair Value Calculation Assumptions (Details)	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected option life	5 years	5 years
Expected dividend yield	0.00%	0.00%
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate	2.63%	1.77%
Expected price volatility	34.06%	33.81%
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate	2.77%	1.83%
Expected price volatility	34.32%	34.07%

Earnings Per Common Share (EPS) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Earnings Per Share, Basic and Diluted [Abstract]
Net income, basic EPS	$ 16,619	$ (3,569)	$ 32,828	$ 20,717
Basic EPS (in shares)	53,431	50,150	51,434	48,332
Basic EPS (in dollars per share)	$ 0.31	$ (0.07)	$ 0.64	$ 0.43
Effect of dilutive stock options and warrants (in shares)	1,672	1,449	1,662	1,223
Net income, diluted EPS	$ 16,619	$ (3,569)	$ 32,828	$ 20,717
Diluted EPS (in shares)	55,103	51,599	53,096	49,555
Diluted EPS (in dollars per share)	$ 0.30	$ (0.07)	$ 0.62	$ 0.42
Stock options excluded from the calculation of common stock equivalents as the impact was anti-dilutive (in shares)	667	200	462	434

- Definition

The amount of net income (loss) for the period per each share of common stock or unit outstanding during the reporting period.

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- Definition

The amount of net income (loss) for the period available to each share of common stock or common unit outstanding during the reporting period and to each share or unit that would have been outstanding assuming the issuance of common shares or units for all dilutive potential common shares or units outstanding during the reporting period.

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+ Details

Acquisitions - Narrative (Details) shares in Thousands, $ in Thousands										1 Months Ended	3 Months Ended	9 Months Ended		12 Months Ended
	May 23, 2018 USD ($)	May 18, 2018 USD ($)	Apr. 06, 2018 USD ($)	Feb. 14, 2018 USD ($)	Oct. 02, 2017 USD ($)	Aug. 04, 2017 USD ($)	Jul. 03, 2017 USD ($)	May 01, 2017 USD ($)	Jan. 31, 2017 USD ($) patents	Jul. 31, 2018 USD ($) shares	Sep. 30, 2018 USD ($)	Sep. 30, 2018 USD ($)	Sep. 30, 2017 USD ($)	Dec. 31, 2017 USD ($)
Business Acquisition [Line Items]
Payments to acquire intangible assets												$ 2,234	$ 1,927
Loan for long-term agreement												10,750	$ 0
QX Medical, LLC
Business Acquisition [Line Items]
Payments to acquire intangible assets		$ 750
NinePoint
Business Acquisition [Line Items]
Option to purchase outstanding equity, up to			100.00%
Consideration received, option to purchase remaining equity			$ 10,000
Net sales related to acquisition											$ 1,400	$ 2,500
Loan for long-term agreement			$ 10,500
Interest rate on loan			9.00%
Distribution agreements \| QX Medical, LLC
Business Acquisition [Line Items]
Useful life		10 years
DirectACCESS Medical, LLC
Business Acquisition [Line Items]
Total purchase price	$ 7,300
Weighted average useful life	9 years 10 months 24 days
DirectACCESS Medical, LLC \| Developed technology
Business Acquisition [Line Items]
Useful life	10 years
DirectACCESS Medical, LLC \| Trademarks
Business Acquisition [Line Items]
Useful life	10 years
DirectACCESS Medical, LLC \| Customer Lists
Business Acquisition [Line Items]
Useful life	5 years
Becton, Dickinson and Company
Business Acquisition [Line Items]
Total purchase price				$ 100,300
Weighted average useful life												8 years
Net sales related to acquisition											11,800	$ 30,300
Acquisition-related costs												$ 1,800
Becton, Dickinson and Company \| Developed technology
Business Acquisition [Line Items]
Useful life												8 years
Becton, Dickinson and Company \| Trademarks
Business Acquisition [Line Items]
Useful life												9 years
Becton, Dickinson and Company \| Customer Lists
Business Acquisition [Line Items]
Useful life												7 years
ITL Healthcare Pty Ltd
Business Acquisition [Line Items]
Total purchase price					$ 11,300
Net sales related to acquisition											1,900	$ 6,100
ITL Healthcare Pty Ltd \| Customer Lists
Business Acquisition [Line Items]
Useful life					7 years
Laurane Medical S.A.S.
Business Acquisition [Line Items]
Total purchase price						$ 16,500
Weighted average useful life						11 years 10 months 24 days
Contingent liability						$ 5,500
Laurane Medical S.A.S. \| Developed technology
Business Acquisition [Line Items]
Useful life						12 years
Laurane Medical S.A.S. \| Customer Lists
Business Acquisition [Line Items]
Useful life						1 year
Osseon LLC
Business Acquisition [Line Items]
Total purchase price							$ 6,800
Weighted average useful life							9 years
Net sales related to acquisition											478	1,600
Osseon LLC \| Developed technology
Business Acquisition [Line Items]
Useful life							9 years
Osseon LLC \| Customer Lists
Business Acquisition [Line Items]
Useful life							8 years
Vascular Access Technologies, Inc.
Business Acquisition [Line Items]
Total purchase price								$ 5,000
Contingent liability								$ 4,900
Vascular Access Technologies, Inc. \| Developed technology
Business Acquisition [Line Items]
Useful life								15 years
Argon Medical Devices, Inc.
Business Acquisition [Line Items]
Total purchase price									$ 10,100
Weighted average useful life									6 years
Net sales related to acquisition											11,000	34,200
Initial payment, before working capital adjustment									$ 10,900
Working capital adjustment									$ (797)
Argon Medical Devices, Inc. \| Cardiovascular Segment
Business Acquisition [Line Items]
Acquisition-related costs														$ 2,600
Argon Medical Devices, Inc. \| Developed technology
Business Acquisition [Line Items]
Useful life									7 years
Argon Medical Devices, Inc. \| Trademarks
Business Acquisition [Line Items]
Useful life									5 years
Argon Medical Devices, Inc. \| Customer Lists
Business Acquisition [Line Items]
Useful life									5 years
Catheter Connections, Inc.
Business Acquisition [Line Items]
Total purchase price									$ 38,000
Weighted average useful life									11 years 8 months 12 days
Net sales related to acquisition											$ 3,700	$ 10,100
Number of patents acquired \| patents									40
Catheter Connections, Inc. \| Cardiovascular Segment
Business Acquisition [Line Items]
Acquisition-related costs														$ 482
Catheter Connections, Inc. \| Developed technology
Business Acquisition [Line Items]
Useful life									12 years
Catheter Connections, Inc. \| Trademarks
Business Acquisition [Line Items]
Useful life									10 years
Catheter Connections, Inc. \| Customer Lists
Business Acquisition [Line Items]
Useful life									8 years
Cagent Vacsular, LLC
Business Acquisition [Line Items]
Preferred limited liability company units (in units) \| shares										1,786
Payments to purchase preferred limited liability company units										$ 2,200
Equity method investment, ownership percentage										19.50%

Acquisitions - Purchase Price Allocation (Details) - USD ($) $ in Thousands								3 Months Ended			9 Months Ended
	May 23, 2018	Feb. 14, 2018	Oct. 02, 2017	Aug. 04, 2017	Jul. 03, 2017	May 01, 2017	Jan. 31, 2017	Sep. 30, 2018	Sep. 30, 2017	Mar. 31, 2017	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017
Assets Acquired
Goodwill								$ 249,023			$ 249,023		$ 238,147
Liabilities Assumed
Gain on bargain purchase								0	$ 778		0	$ (10,796)
DirectACCESS Medical, LLC
Assets Acquired
Inventories	$ 971
Goodwill	938
Total assets acquired	7,269
Liabilities Assumed
Total purchase price	7,300
DirectACCESS Medical, LLC \| Developed technology
Assets Acquired
Intangibles	4,840
DirectACCESS Medical, LLC \| Customer lists
Assets Acquired
Intangibles	120
DirectACCESS Medical, LLC \| Trademarks
Assets Acquired
Intangibles	$ 400
Becton, Dickinson and Company
Assets Acquired
Inventories								5,804			5,804
Property and equipment								748			748
Goodwill								10,613			10,613
Total assets acquired								100,265			100,265
Liabilities Assumed
Total purchase price		$ 100,300
Becton, Dickinson and Company \| Developed technology
Assets Acquired
Intangibles								74,000			74,000
Becton, Dickinson and Company \| Customer lists
Assets Acquired
Intangibles								4,200			4,200
Becton, Dickinson and Company \| Trademarks
Assets Acquired
Intangibles								$ 4,900			$ 4,900
ITL Healthcare Pty Ltd
Assets Acquired
Trade receivables			$ 1,287
Other receivables			56
Inventories			1,808
Prepaid expenses and other assets			65
Property and equipment			1,053
Goodwill			3,945
Total assets acquired			14,154
Liabilities Assumed
Trade payables			(216)
Accrued expenses			(747)
Deferred income tax liabilities			(1,901)
Total liabilities assumed			(2,864)
Total net assets acquired			11,290
Total purchase price			11,300
ITL Healthcare Pty Ltd \| Customer lists
Assets Acquired
Intangibles			$ 5,940
Laurane Medical S.A.S.
Assets Acquired
Inventories				$ 594
Goodwill				6,366
Total assets acquired				22,000
Liabilities Assumed
Total purchase price				16,500
Laurane Medical S.A.S. \| Developed technology
Assets Acquired
Intangibles				14,920
Laurane Medical S.A.S. \| Customer lists
Assets Acquired
Intangibles				$ 120
Osseon LLC
Assets Acquired
Inventories					$ 979
Property and equipment					58
Goodwill					203
Total assets acquired					6,840
Liabilities Assumed
Total purchase price					6,800
Osseon LLC \| Developed technology
Assets Acquired
Intangibles					5,400
Osseon LLC \| Customer lists
Assets Acquired
Intangibles					$ 200
Vascular Access Technologies, Inc.
Assets Acquired
Goodwill						$ 4,281
Liabilities Assumed
Deferred income tax liabilities						(3,101)
Total net assets acquired						9,900
Total purchase price						5,000
Vascular Access Technologies, Inc. \| Developed technology
Assets Acquired
Intangibles						7,800
Vascular Access Technologies, Inc. \| In-process technology
Assets Acquired
Intangibles						$ 920
Argon Medical Devices, Inc.
Assets Acquired
Cash and cash equivalents							$ 1,436
Trade receivables							8,351
Inventories							11,222
Prepaid expenses and other assets							1,275
Income tax refund receivables							165
Property and equipment							2,319
Deferred income tax assets							202
Total assets acquired							29,570
Liabilities Assumed
Trade payables							(2,414)
Accrued expenses							(5,083)
Deferred income tax liabilities							(934)
Total liabilities assumed							(8,431)
Total net assets acquired							21,139
Gain on bargain purchase							(11,039)
Total purchase price							10,100
Negative adjustment (Argon Medical Devices, Inc.)										$ 1,200
Argon Medical Devices, Inc. \| Developed technology
Assets Acquired
Intangibles							2,200
Argon Medical Devices, Inc. \| Customer lists
Assets Acquired
Intangibles							1,500
Argon Medical Devices, Inc. \| Trademarks
Assets Acquired
Intangibles							900
Catheter Connections, Inc.
Assets Acquired
Trade receivables							958
Inventories							2,157
Prepaid expenses and other assets							85
Property and equipment							1,472
Goodwill							8,989
Total assets acquired							38,361
Liabilities Assumed
Trade payables							(338)
Accrued expenses							(23)
Total liabilities assumed							(361)
Total net assets acquired							38,000
Total purchase price							38,000
Catheter Connections, Inc. \| Developed technology
Assets Acquired
Intangibles							21,100
Catheter Connections, Inc. \| Customer lists
Assets Acquired
Intangibles							700
Catheter Connections, Inc. \| Trademarks
Assets Acquired
Intangibles							$ 2,900

Acquisitions - Summary of Unaudited Consolidated Results of Operations, Including Proforma Results (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
As Reported
Net sales	$ 221,659	$ 179,337	$ 649,504	$ 536,955
Net income	$ 16,619	$ (3,569)	$ 32,828	$ 20,717
Basic (in dollars per share)	$ 0.31	$ (0.07)	$ 0.64	$ 0.43
Diluted (in dollars per share)	$ 0.30	$ (0.07)	$ 0.62	$ 0.42
Pro Forma
Net sales				$ 539,715
Net income				$ 10,039
Basic (in dollars per share)				$ 0.21
Diluted (in dollars per share)				$ 0.20

Revenue from Contracts with Customers - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Disaggregation of Revenue [Line Items]
Net sales	$ 221,659	$ 179,337	$ 649,504	$ 536,955
United States
Disaggregation of Revenue [Line Items]
Net sales	126,108	103,091	360,610	313,314
International
Disaggregation of Revenue [Line Items]
Net sales	95,551	76,246	288,894	223,641
Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	212,150	172,723	624,392	517,140
Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	116,879	96,702	336,341	294,119
Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	95,271	76,021	288,051	223,021
Endoscopy
Disaggregation of Revenue [Line Items]
Net sales	9,509	6,614	25,112	19,815
Stand-alone devices \| Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	90,975	68,749	266,717	203,459
Stand-alone devices \| Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	52,173	36,383	147,125	109,750
Stand-alone devices \| Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	38,802	32,366	119,592	93,709
Custom kits and procedure trays \| Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	33,095	30,411	100,359	91,082
Custom kits and procedure trays \| Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	23,199	23,085	69,184	68,823
Custom kits and procedure trays \| Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	9,896	7,326	31,175	22,259
Inflation devices \| Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	22,893	20,033	69,617	59,329
Inflation devices \| Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	7,819	8,241	23,647	24,257
Inflation devices \| Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	15,074	11,792	45,970	35,072
Catheters \| Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	40,591	31,751	113,830	94,357
Catheters \| Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	18,081	15,377	50,055	46,529
Catheters \| Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	22,510	16,374	63,775	47,828
Embolization devices \| Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	12,395	12,252	37,706	36,936
Embolization devices \| Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	5,145	5,414	15,272	16,548
Embolization devices \| Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	7,250	6,838	22,434	20,388
CRM/EP \| Cardiovascular
Disaggregation of Revenue [Line Items]
Net sales	12,201	9,527	36,163	31,977
CRM/EP \| Cardiovascular \| United States
Disaggregation of Revenue [Line Items]
Net sales	10,462	8,202	31,058	28,212
CRM/EP \| Cardiovascular \| International
Disaggregation of Revenue [Line Items]
Net sales	1,739	1,325	5,105	3,765
Endoscopy devices \| Endoscopy
Disaggregation of Revenue [Line Items]
Net sales	9,509	6,614	25,112	19,815
Endoscopy devices \| Endoscopy \| United States
Disaggregation of Revenue [Line Items]
Net sales	9,229	6,389	24,269	19,195
Endoscopy devices \| Endoscopy \| International
Disaggregation of Revenue [Line Items]
Net sales	$ 280	$ 225	$ 843	$ 620

Segment Reporting - Operating Income (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Segment Reporting Information [Line Items]
Net sales	$ 221,659	$ 179,337	$ 649,504	$ 536,955
Operating income	21,061	879	44,955	19,850
Cardiovascular
Segment Reporting Information [Line Items]
Net sales	212,150	172,723	624,392	517,140
Operating income	18,199	(1,207)	37,263	14,239
Endoscopy
Segment Reporting Information [Line Items]
Net sales	9,509	6,614	25,112	19,815
Operating income	$ 2,862	$ 2,086	$ 7,692	$ 5,611

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
Income Taxes - Narrative (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Income Tax Disclosure [Abstract]
Income tax expense	$ 2,766	$ 1,364	$ 4,481	$ 3,884
Effective tax rate	14.30%	(61.90%)	12.00%	15.80%

Revolving Credit Facility and Long-Term Debt - Principal Balances under Long-term Debt (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Sep. 03, 2018	Dec. 31, 2017
Line of Credit Facility [Line Items]
Total long-term debt	$ 208,867		$ 278,472
Collateralized debt facility	7,000	$ 7,000	6,959
Less unamortized debt issuance costs	(383)		(487)
Less current portion	22,000		19,459
Long-term portion	186,867		259,013
Term Loan
Line of Credit Facility [Line Items]
Total long-term debt	76,250		85,000
Revolving Credit Facility
Line of Credit Facility [Line Items]
Total long-term debt	$ 126,000		$ 187,000

Revolving Credit Facility and Long-Term Debt - Narrative (Details) - USD ($)		9 Months Ended
	Sep. 03, 2018	Sep. 30, 2018	Dec. 31, 2017	Dec. 13, 2017	Jul. 06, 2016
Line of Credit Facility [Line Items]
Outstanding borrowings		$ 209,250,000
Collateralized debt facility	$ 7,000,000.0	$ 7,000,000	$ 6,959,000
Variable rate on loan		3.12%
LIBOR
Line of Credit Facility [Line Items]
Debt instrument, basis spread on variable rate	1.00%
Credit Agreement
Line of Credit Facility [Line Items]
Outstanding borrowings		$ 202,300,000
Remaining borrowing capacity on line of credit		248,400,000
Fixed interest rate percent			2.68%
Debt subject to fixed interest rate		$ 175,000,000.0	$ 175,000,000
Credit Agreement \| Variable Rate
Line of Credit Facility [Line Items]
Variable interest rate percent		3.99%	2.82%
Debt subject to variable interest rate		$ 27,300,000	$ 97,000,000
Credit Agreement \| Interest Rate Swap
Line of Credit Facility [Line Items]
Fixed interest rate percent		2.87%
Credit Agreement \| Revolving Credit Facility
Line of Credit Facility [Line Items]
Increase to revolving credit commitment				$ 100,000,000
Maximum borrowing capacity				$ 375,000,000
Interest rate increase if in event of default		2.00%
Credit Agreement \| Revolving Credit Facility \| Minimum
Line of Credit Facility [Line Items]
Commitment fee percentage		0.15%
Credit Agreement \| Revolving Credit Facility \| Maximum
Line of Credit Facility [Line Items]
Commitment fee percentage		0.40%
Credit Agreement \| Term Loan
Line of Credit Facility [Line Items]
Debt instrument, face amount					$ 150,000,000
Credit Agreement \| Bridge Loan
Line of Credit Facility [Line Items]
Maximum borrowing capacity					$ 25,000,000

Revolving Credit Facility and Long-Term Debt - Financial Covenants (Details) - Credit Agreement	9 Months Ended
	Sep. 30, 2018 USD ($)
Debt Instrument [Line Items]
Consolidated EBITDA	1.25
Consolidated Net Income	$ 0
Facility Capital Expenditures	$ 30,000,000
January 1, 2018 and thereafter
Debt Instrument [Line Items]
Consolidated Total Leverage Ratio	3.50

Revolving Credit Facility and Long-Term Debt - Future Minimum Payments on Long-term Debt (Details) $ in Thousands	Sep. 30, 2018 USD ($)
Debt Disclosure [Abstract]
Remaining 2018	$ 3,750
2019	22,000
2020	17,500
2021	166,000
Total future minimum principal payments	$ 209,250

Derivatives - Narrative (Details) € in Thousands, ₩ in Thousands, ¥ in Thousands, ¥ in Thousands, £ in Thousands, kr in Thousands, kr in Thousands, SFr in Thousands, R$ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands	9 Months Ended
	Sep. 30, 2018 USD ($)	Sep. 30, 2018 CNY (¥) derivative_instrument	Sep. 30, 2018 SGD ($) derivative_instrument	Sep. 30, 2018 EUR (€) derivative_instrument	Sep. 30, 2018 SEK (kr) derivative_instrument	Sep. 30, 2018 GBP (£) derivative_instrument	Sep. 30, 2018 KRW (₩) derivative_instrument	Sep. 30, 2018 JPY (¥) derivative_instrument	Sep. 30, 2018 AUD ($) derivative_instrument	Sep. 30, 2018 DKK (kr) derivative_instrument	Sep. 30, 2018 USD ($) derivative_instrument	Sep. 30, 2018 HKD ($) derivative_instrument	Sep. 30, 2018 CAD ($) derivative_instrument	Sep. 30, 2018 MXN ($) derivative_instrument	Sep. 30, 2018 BRL (R$) derivative_instrument	Sep. 30, 2018 CHF (SFr) derivative_instrument	Dec. 31, 2017 USD ($)	Aug. 05, 2016 USD ($)
Derivative [Line Items]
Deferred taxes used to offset fair value of interest rate swap											$ (2,100)						$ (1,500)
Maturity of derivative contract (up to)	2 years
Revenue and cost of sales
Derivative [Line Items]
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, gross	$ 858
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, net of tax	637
Interest expense
Derivative [Line Items]
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, gross	2,600
Amount expected to be reclassified from accumulated other comprehensive income to earnings in next twelve months, net of tax	$ 2,000
Interest rate swap
Derivative [Line Items]
Notional amount of derivative																		$ 175,000
Fixed rate																		1.12%
Deferred taxes used to offset fair value of interest rate swap											$ (2,100)
Foreign currency forward contracts \| Designated as hedging instrument
Derivative [Line Items]
Average number of contracts entered into per month \| derivative_instrument		150	150	150	150	150	150	150	150	150	150	150	150	150	150	150
Foreign currency forward contracts \| Not designated as hedging instrument
Derivative [Line Items]
Notional amount of derivative		¥ 95,228	$ 6,900	€ 25,861	kr 10,536	£ 1,584	₩ 2,700,000	¥ 260,000	$ 11,150	kr 2,885		$ 11,000	$ 3,098	$ 18,700	R$ 8,500	SFr 255
Average number of contracts entered into per month \| derivative_instrument		20	20	20	20	20	20	20	20	20	20	20	20	20	20	20
Other assets (long-term) \| Interest rate swap \| Designated as hedging instrument
Derivative [Line Items]
Total Asset Derivatives											$ 8,284						5,749
Other assets (long-term) \| Foreign currency forward contracts \| Designated as hedging instrument
Derivative [Line Items]
Total Asset Derivatives											$ 161						$ 35

Derivatives - Forward Notional Contracts (Details) - Sep. 30, 2018 - Foreign currency forward contracts € in Thousands, ₩ in Thousands, ¥ in Thousands, ¥ in Thousands, £ in Thousands, kr in Thousands, kr in Thousands, SFr in Thousands, R$ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands, $ in Thousands	SGD ($)	EUR (€)	SEK (kr)	GBP (£)	KRW (₩)	JPY (¥)	AUD ($)	CNY (¥)	DKK (kr)	HKD ($)	CAD ($)	MXN ($)	BRL (R$)	CHF (SFr)
Designated as hedging instrument \| Derivatives designated as cash flow hedges
Derivative [Line Items]
Notional amount of derivative		€ 12,270	kr 12,780	£ 3,355		¥ 330,000		¥ 60,000	kr 10,835		$ 2,460	$ 93,575		SFr 1,215
Not designated as hedging instrument
Derivative [Line Items]
Notional amount of derivative	$ 6,900	€ 25,861	kr 10,536	£ 1,584	₩ 2,700,000	¥ 260,000	$ 11,150	¥ 95,228	kr 2,885	$ 11,000	$ 3,098	$ 18,700	R$ 8,500	SFr 255

Derivatives - Fair Value of Derivative Instruments (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Designated as hedging instrument \| Interest rate swap \| Other assets (long-term)
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	$ 8,284	$ 5,749
Designated as hedging instrument \| Foreign currency forward contracts \| Other assets (long-term)
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	161	35
Designated as hedging instrument \| Foreign currency forward contracts \| Prepaid expenses and other assets
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	813	363
Designated as hedging instrument \| Foreign currency forward contracts \| Accrued expenses
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	(240)	(468)
Designated as hedging instrument \| Foreign currency forward contracts \| Other long-term obligations
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	(56)	(82)
Not designated as hedging instrument \| Foreign currency forward contracts \| Prepaid expenses and other assets
Derivatives, Fair Value [Line Items]
Total Asset Derivatives	360	223
Not designated as hedging instrument \| Foreign currency forward contracts \| Accrued expenses
Derivatives, Fair Value [Line Items]
Total Liability Derivatives	$ (475)	$ (841)

Derivatives - Amount of Gain (Loss) Recognized in OCI and Income Statement (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) Recognized in OCI	$ 667	$ (144)	$ 3,541	$ 166
Derivatives designated as cash flow hedges \| Interest rate swap
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) Recognized in OCI	664	1	3,532	(611)
Derivatives designated as cash flow hedges \| Interest rate swap \| Interest Expense
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) Reclassified from AOCI	428	96	998	(8)
Derivatives designated as cash flow hedges \| Foreign currency forward contracts
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) Recognized in OCI		100		841
Derivatives designated as cash flow hedges \| Foreign currency forward contracts \| Revenue
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) Recognized in OCI	543		1,112
Amount of Gain/(Loss) Reclassified from AOCI	86	(101)	(299)	(141)
Derivatives designated as cash flow hedges \| Foreign currency forward contracts \| Cost of sales
Derivative Instruments, Gain (Loss) [Line Items]
Amount of Gain/(Loss) Reclassified from AOCI	$ 26	$ 250	$ 404	$ 213

Derivatives - Gain (Loss) in the Consolidated Statements of Income (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Not designated as hedging instrument \| Foreign currency forward contracts \| Other expense
Derivative [Line Items]
Gain (loss) on derivative	$ 1,143	$ (1,459)	$ 3,181	$ (4,150)

Fair Value Measurements - Financial Assets and (Liabilities) Carried at Fair Value (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Fair Value, Inputs, Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contracts	$ 0	$ 0
Foreign currency contract assets, current and long-term	0	0
Foreign currency contract liabilities, current and long-term	0	0
Fair Value, Inputs, Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contracts	8,284	5,749
Foreign currency contract assets, current and long-term	1,334	621
Foreign currency contract liabilities, current and long-term	(771)	(1,391)
Fair Value, Inputs, Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contracts	0	0
Foreign currency contract assets, current and long-term	0	0
Foreign currency contract liabilities, current and long-term	0	0
Estimate of Fair Value, Fair Value Disclosure
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate contracts	8,284	5,749
Foreign currency contract assets, current and long-term	1,334	621
Foreign currency contract liabilities, current and long-term	$ (771)	$ (1,391)

Fair Value Measurements - Liability Measured on Recurring Basis, Unobservable Input Reconciliation (Details) - Contingent Consideration - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ 10,912	$ 5,572	$ 10,956	$ 683
Contingent consideration liability recorded as the result of acquisitions (see Note 5)	0	5,500	0	10,400
Fair value adjustments recorded to income during the period	(828)	20	(741)	39
Contingent payments made	(53)	(15)	(184)	(45)
Ending balance	$ 10,031	$ 11,077	$ 10,031	$ 11,077

Fair Value Measurements - Fair Value Inputs, Liabilities, Quantitative Information (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Jun. 30, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Dec. 31, 2016
Contingent Consideration
Fair Value Inputs, Liabilities, Quantitative Information [Line Items]
Contingent consideration liability	$ 10,031	$ 10,912	$ 10,956	$ 11,077	$ 5,572	$ 683
Revenue-based Payments \| Contingent Consideration
Fair Value Inputs, Liabilities, Quantitative Information [Line Items]
Contingent consideration liability	$ 10,031		$ 10,956
Measurement Input, Discount Rate \| Revenue-based Payments \| Contingent Consideration \| Minimum \| Discounted Cash Flow \| Fair Value, Inputs, Level 3
Fair Value Inputs, Liabilities, Quantitative Information [Line Items]
Unobservable inputs, contingent liability	9.90%		9.90%
Measurement Input, Discount Rate \| Revenue-based Payments \| Contingent Consideration \| Maximum \| Discounted Cash Flow \| Fair Value, Inputs, Level 3
Fair Value Inputs, Liabilities, Quantitative Information [Line Items]
Unobservable inputs, contingent liability	15.00%		15.00%
Milestone Payment Probability \| Revenue-based Payments \| Contingent Consideration \| Discounted Cash Flow \| Fair Value, Inputs, Level 3
Fair Value Inputs, Liabilities, Quantitative Information [Line Items]
Unobservable inputs, contingent liability			100.00%
Contingent Receivable \| Other Payments
Fair Value Inputs, Liabilities, Quantitative Information [Line Items]
Contingent consideration asset	$ 308		$ 760
Contingent Receivable \| Measurement Input, Discount Rate \| Other Payments \| Discounted Cash Flow \| Fair Value, Inputs, Level 3
Fair Value Inputs, Liabilities, Quantitative Information [Line Items]
Unobservable inputs, contingent receivable asset	10.00%		10.00%
Contingent Receivable \| Milestone Payment Probability \| Other Payments \| Discounted Cash Flow \| Fair Value, Inputs, Level 3
Fair Value Inputs, Liabilities, Quantitative Information [Line Items]
Unobservable inputs, contingent receivable asset	35.00%		75.00%

Fair Value Measurements - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment of other assets	$ 0	$ 67	$ 86	$ 86
Other Payments \| Contingent Receivable
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Remaining contingent receivable asset	308		308		$ 760
Contingent Receivable \| Contingent Consideration
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Gain (loss) on contingent receivable	167		299
Payment received on contingent receivable	0		153
Other long-term obligations
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration liability, noncurrent	9,800		9,800		10,700
Accrued expenses
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration liability, current	$ 280		$ 280		289
Other assets (long-term) \| Contingent Receivable \| Contingent Consideration
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Remaining contingent receivable asset					319
Other current assets \| Contingent Receivable \| Contingent Consideration
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Remaining contingent receivable asset					$ 441

Goodwill and Intangible Assets - Goodwill (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2018 USD ($)
Goodwill [Roll Forward]
Goodwill balance at January 1	$ 238,147
Effect of foreign exchange	(881)
Additions as the result of acquisitions	11,757
Goodwill balance at September 30	$ 249,023

Goodwill and Intangible Assets - Other Intangible Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Other
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 110,653	$ 97,680
Accumulated Amortization	(46,088)	(38,127)
Net Carrying Amount	64,565	59,553
Patents
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	18,676	16,528
Accumulated Amortization	(4,665)	(3,737)
Net Carrying Amount	14,011	12,791
Distribution agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	8,012	7,262
Accumulated Amortization	(5,509)	(4,686)
Net Carrying Amount	2,503	2,576
License agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	24,913	23,783
Accumulated Amortization	(6,895)	(5,568)
Net Carrying Amount	18,018	18,215
Trademarks
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	21,514	16,224
Accumulated Amortization	(6,039)	(4,686)
Net Carrying Amount	15,475	11,538
Covenants not to compete
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	1,028	1,028
Accumulated Amortization	(993)	(968)
Net Carrying Amount	35	60
Customer lists
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	35,590	31,935
Accumulated Amortization	(21,987)	(18,482)
Net Carrying Amount	13,603	13,453
In-process technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	920	920
Accumulated Amortization	0	0
Net Carrying Amount	$ 920	$ 920

Goodwill and Intangible Assets - Narrative (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Finite-Lived Intangible Assets [Line Items]
Accumulated impairment loss	$ 8,300,000		$ 8,300,000
Aggregate amortization expense	10,500,000	$ 7,000,000.0	29,400,000	$ 19,400,000
Intangible asset impairment charge	657,000	$ 0	$ 657,000	$ 0
Quellent, LLC
Finite-Lived Intangible Assets [Line Items]
Intangible asset impairment charge	$ 657,000

Goodwill and Intangible Assets - Future Amortization Expense (Details) $ in Thousands	Sep. 30, 2018 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Remaining 2018	$ 10,140
2019	39,647
2020	38,386
2021	31,025
2022	$ 29,141

Commitments and Contingencies (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2018
U.S. Department of Justice Matter
Loss Contingencies [Line Items]
Legal expenses	$ 946	$ 4,300

Issuance of Common Stock (Details) - USD ($) $ in Thousands	Jul. 30, 2018	Mar. 28, 2017
Equity [Abstract]
Common stock issued in transaction (in shares)	4,025,000	5,175,000
Net proceeds from issuance of common stock	$ 205,400	$ 136,600
Underwriting discounts and commissions	12,000	8,800
Other direct costs incurred	$ 366	$ 816

Subsequent Events - Narrative (Details) - Subsequent Event - Cianna Medical, Inc. - Scenario, Plan	Oct. 01, 2018 USD ($)
Subsequent Event [Line Items]
Total purchase price	$ 200,000,000
Cash paid for merger at closing	135
Certain Manufacturing Capacity and Manufacturing Cost Milestone
Subsequent Event [Line Items]
Earn-out payment payable upon certain milestones	15,000,000
Annual Net Sales Milestone
Subsequent Event [Line Items]
Earn-out payment payable upon certain milestones	$ 50,000,000
Aggregate earn-out payment rate	175.00%

Segment Reporting - Narrative (Details)	9 Months Ended
Segment Reporting - Narrative (Details)	Sep. 30, 2018 segment
Segment Reporting [Abstract]
Number of operating segments	2