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Segment Reporting and Foreign Operations - Operating Income (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended
--- | --- | ---
Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Net Sales | $ 190,897 | $ 179,337 | $ 186,549 | $ 171,069 | $ 157,715 | $ 156,975 | $ 151,071 | $ 138,077 | $ 727,852 | $ 603,838 | $ 542,149
Operating expenses |  |  |  |  |  |  |  |  | 293,184 | 230,149 | 198,238
Operating income (loss) | 13,219 | 879 | 13,362 | 5,609 | 12,602 | 2,987 | 11,581 | 7,706 | 33,069 | 34,876 | 37,543
Total other expense - net |  |  |  |  |  |  |  |  | 2,812 | (9,490) | (6,343)
Income tax expense | 4,474 | 1,364 | 1,830 | 690 | 2,116 | (978) | 2,572 | 1,555 | 8,358 | 5,265 | 7,398
NET INCOME | $ 6,806 | $ (3,569) | $ 9,483 | $ 14,803 | $ 7,507 | $ 973 | $ 7,290 | $ 4,351 | 27,523 | 20,121 | 23,802
Cardiovascular |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Net Sales |  |  |  |  |  |  |  |  | 700,613 | 580,151 | 520,915
Operating expenses |  |  |  |  |  |  |  |  | 281,095 | 218,659 | 187,492
Operating income (loss) |  |  |  |  |  |  |  |  | 24,819 | 30,053 | 34,052
Endoscopy |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Net Sales |  |  |  |  |  |  |  |  | 27,239 | 23,687 | 21,234
Operating expenses |  |  |  |  |  |  |  |  | 12,089 | 11,490 | 10,746
Operating income (loss) |  |  |  |  |  |  |  |  | $ 8,250 | $ 4,823 | $ 3,491

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