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Goodwill and Intangible Assets | 12 Months Ended
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Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract] |
Goodwill and Intangible Assets | 5.GOODWILL AND INTANGIBLE ASSETS The changes in the carrying amount of goodwill for the years ended December 31, 2022 and 2021, are as follows (in thousands):
​ | ​ | ​ | ​ | ​ | ​ | ​
​ |  | 2022 |  | 2021
Goodwill balance at January 1 | ​ | $ | 361,741 | ​ | $ | 363,533
Effect of foreign exchange | ​ |  | (1,920) | ​ |  | (2,078)
Additions and adjustments as the result of acquisitions | ​ |  | — | ​ |  | 286
Goodwill balance at December 31 | ​ | $ | 359,821 | ​ | $ | 361,741
​ Total accumulated goodwill impairment losses aggregated to $8.3 million as of December 31, 2022 and 2021. We did not have any goodwill impairments for the years ended December 31, 2022, 2021 and 2020. The total goodwill balance as of December 31, 2022 and 2021 is related to our cardiovascular segment. Other intangible assets at December 31, 2022 and 2021, consisted of the following (in thousands):
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
​ | ​ | December 31, 2022
​ | ​ | Gross Carrying | ​ | Accumulated | ​ | Net Carrying
​ |  | Amount |  | Amortization |  | Amount
Patents | ​ | $ | 29,445 | ​ | $ | (10,203) | ​ | $ | 19,242
Distribution agreements | ​ |  | 3,250 | ​ |  | (2,715) | ​ |  | 535
License agreements | ​ |  | 11,109 | ​ |  | (7,250) | ​ |  | 3,859
Trademarks | ​ |  | 30,221 | ​ |  | (17,863) | ​ |  | 12,358
Customer lists | ​ |  | 34,105 | ​ |  | (31,749) | ​ |  | 2,356
Total | ​ | $ | 108,130 | ​ | $ | (69,780) | ​ | $ | 38,350
​
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
​ | ​ | December 31, 2021
​ | ​ | Gross Carrying | ​ | Accumulated | ​ | Net Carrying
​ |  | Amount |  | Amortization |  | Amount
Patents | ​ | $ | 26,349 | ​ | $ | (8,315) | ​ | $ | 18,034
Distribution agreements | ​ |  | 3,250 | ​ |  | (2,519) | ​ |  | 731
License agreements | ​ |  | 12,663 | ​ |  | (7,768) | ​ |  | 4,895
Trademarks | ​ |  | 30,242 | ​ |  | (15,256) | ​ |  | 14,986
Customer lists | ​ |  | 34,985 | ​ |  | (31,195) | ​ |  | 3,790
Total | ​ | $ | 107,489 | ​ | $ | (65,053) | ​ | $ | 42,436
​ Aggregate amortization expense for the years ended December 31, 2022, 2021 and 2020 was $48.4 million, $49.6 million, and $58.6 million, respectively. Estimated amortization expense for the developed technology and other intangible assets for the next five years consists of the following as of December 31, 2022 (in thousands):
​ | ​ | ​ | ​
Year Ending December 31, |  | Estimated Amortization Expense
2023 | ​ | $ | 47,496
2024 | ​ |  | 44,434
2025 | ​ |  | 42,610
2026 | ​ | ​ | 32,040
2027 | ​ |  | 28,966
​ During the years ended December 31, 2022, 2021 and 2020, we identified indicators of impairment associated with certain acquired intangible assets based on our qualitative assessment that carrying amounts may not be recoverable, which required us to then complete a quantitative impairment assessment. The primary indicators of impairment were planned closure and restructuring activities and uncertainty about future product development and commercialization associated with certain acquired technologies, due in part to the economic impacts of the COVID-19 pandemic in 2021 and 2020. During the year ended December 31, 2022, we recorded total impairment charges related to our intangible assets of $1.7 million for our divestiture on April 30, 2022 of the STD Pharmaceutical Products Limited (“STD Pharmaceutical”) business acquired in our August 2019 acquisition of Fibrovein Holdings Limited. During the year ended December 31, 2021, we recorded total impairment charges related to our intangible assets of $1.6 million for the remaining carrying value of ArraVasc license agreements. During the year ended December 31, 2020, we recorded total impairment charges related to our intangible assets of $28.7 million which included a partial impairment charge of $8.2 million of intangible assets from our acquisition of STD Pharmaceutical, a partial impairment charge of $8.0 million of intangible assets from our acquisition of certain assets from Laurane Medical S.A.S, a partial impairment charge of $4.8 million related to our license agreements with ArraVasc Limited, and other intangible asset impairments charges of $7.7 million related to intangible assets from our acquisition of certain assets from DirectACCESS Medical, LLC, in-process technology intangible assets of Sontina Medical LLC acquired in connection with our acquisition of certain divested assets from Becton, Dickinson and Company, and a customer list intangible asset from our acquisition of ITL Healthcare Pty Ltd (“ITL”).

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