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Goodwill and Intangible Assets | 12 Months Ended
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Dec. 31, 2023
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, 2023 and 2022, are as follows (in thousands):
​ | ​ | ​ | ​ | ​ | ​ | ​
​ |  | 2023 |  | 2022
Goodwill balance at January 1 | ​ | $ | 359,821 | ​ | $ | 361,741
Effect of foreign exchange | ​ |  | 883 | ​ |  | (1,920)
Additions and adjustments as the result of acquisitions | ​ |  | 21,536 | ​ |  | —
Goodwill balance at December 31 | ​ | $ | 382,240 | ​ | $ | 359,821
​ Total accumulated goodwill impairment losses aggregated to $8.3 million as of December 31, 2023 and 2022. We did not have any goodwill impairments for the years ended December 31, 2023, 2022 and 2021. The total goodwill balance as of December 31, 2023 and 2022 is related to our cardiovascular segment. Other intangible assets at December 31, 2023 and 2022, consisted of the following (in thousands):
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
​ | ​ | December 31, 2023
​ | ​ | Gross Carrying | ​ | Accumulated | ​ | Net Carrying
​ |  | Amount |  | Amortization |  | Amount
Patents | ​ | $ | 28,877 | ​ | $ | (10,916) | ​ | $ | 17,961
Distribution agreements | ​ |  | 3,250 | ​ |  | (2,919) | ​ |  | 331
License agreements | ​ |  | 11,142 | ​ |  | (8,327) | ​ |  | 2,815
Trademarks | ​ |  | 35,135 | ​ |  | (20,804) | ​ |  | 14,331
Customer lists | ​ |  | 40,367 | ​ |  | (33,921) | ​ |  | 6,446
Total | ​ | $ | 118,771 | ​ | $ | (76,887) | ​ | $ | 41,884
​
​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​ | ​
​ | ​ | 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
​ Aggregate amortization expense for the years ended December 31, 2023, 2022 and 2021 was $56.1 million, $48.4 million, and $49.6 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, 2023 (in thousands):
​ | ​ | ​ | ​
​ |  | Estimated Amortization Expense
2024 | ​ | $ | 62,244
2025 | ​ |  | 60,127
2026 | ​ |  | 49,037
2027 | ​ | ​ | 45,619
2028 | ​ |  | 44,230
​ We evaluate our intangible assets for impairment whenever events or changes in circumstances indicate that their carrying amounts may not be recoverable. During the year ended December 31, 2023, we recorded no impairment charges related to our intangible assets. 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, which pertained to our cardiovascular segment. 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, which pertained to our cardiovascular segment. The primary indicators of impairment were restructuring activities and uncertainty about future product development and commercialization associated with certain acquired technologies.

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