REFERENCE CODE GDME1117CFR PUBLICAT ION DATE OCTOBER 2014 AORTIC STENT GRAFTS EU ANALYSIS AND MARKET FORECASTS

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1 REFERENCE CODE GDME1117CFR PUBLICAT ION DATE OCTOBER 2014 AORTIC STENT GRAFTS

2 Executive Summary Table below provides the key metrics for aortic stent grafts in the 5EU (France, Germany, Italy, Spain, and UK,). Aortic Stent Grafts, Key Metrics in Major Markets (2013) Procedure Volume of Abdominal Aortic Aneurysms (2013) Procedure Volume of Thoracic Aortic Aneurysms 24,773 5,981 5EU $288m Key Events ( ) (2014) Cordis Corporation of Johnson & Johnson; the INCRAFT endograft is currently undergoing clinical trials in Europe, Japan, and the US; it is expected to be approved in 2014, 2018, and 2017 in each of the territories, respectively. (2014) Strong expectation from Endologix to continue to acquire more market share, thereby slicing into the top three players shares. (2014) Medtronic to acquire Covidien for $42.9bn, which can result in cuts in their endovascular business. (2014) Strong pipeline of stent grafts with good pipeline products from Asian and Western players. Competitive Assessment Impact Number of Devices in Marketing Phase 56 5EU $445m Source: GlobalData; primary research interviews with leading vascular surgeons in 5EU 5EU = France, Germany, Italy, Spain, and UK Sales for Aortic Stent Grafts The total aortic stent graft sales market in 2013 was estimated to be $288m across the 5EU. By the end of the forecast, the stent graft sales market will grow to over $445m, with a Compound Annual Growth Rate (CAGR) of 6.4%. The key drivers for the market in the forecast are: The growing prevalence of aortic aneurysms along with the aging population across the globe with hypertension and obesity. The growing technological advancement in minimally invasive procedures and the desire to eliminate the need for open surgical procedures for aneurysms. The major underserved population for minimally invasive aneurysm treatment in the emerging markets that is driving the procedural numbers up. The unmet need for better clinical outcomes and long-term studies to reduce the risk of endoleaks and other complications. 2

3 Executive Summary Figure below depicts the projected growth revenue for aortic stent grafts in the 5EU from 2013 to Aortic Stent Graft Revenue by Major Market ( ) 8% 27% 8% 28% 12% 11% 2013 $288m 2020 $445m 18% 18% 35% 35% France Germany Italy Spain UK Source: GlobalData; primary research interviews and surveys with leading vascular surgeons in the 5EU The European Union (EU) forms about 24% of the global share in The EU is technologically the most advanced market, with the best availability of fenestrated and custom stent grafts on the market. The emerging markets see the most open surgical procedures, but stent use is restricted due to the cost of the products and procedures. As training programs for surgeons increase and product prices decrease, the emerging markets will present a strong opportunity for additional revenue for manufacturers. The overall CAGR across all EU markets is 6.4%, with XYZ representing the biggest growth opportunities. The growing concerns for multinational companies reside with the need to better target the fast-growing markets and the need to continue to be the leader in development to combat the threat of rising local manufacturers. Technological Trends Within the last twenty years, endovascular products have dramatically changed with development relating to improved navigation, trackability, and flexibility, as well as with the stability of access, especially through tortuous anatomy. Imaging technology has had an immense impact on the treatment rates and detection of aneurysms as well. The advances in ultrasound technology have greatly reduced the incidence of aneurysm rupture. As a result of better detection, there can be earlier intervention and fewer open surgeries, thereby resulting in more stent graft placement. 3

4 Executive Summary The technological developments in endovascular repair will essentially continue to result in positive growth. The primary technological drivers include the development of ultra-low profile systems to access difficult anatomies and arteries that are smaller in diameter. The customized fenestrated products have provided a major opportunity for physicians to treat a new patient pool that was only subject to open repair. Thoracic endovascular aneurysm repair (TEVAR) is also an area that is still in its infancy, thus yielding low procedure numbers. As there is more development in those product lines and as the abdominal aortic stent graft product matures, there can be a strong platform for development in the abdominal market as well. Generally, there is still much room for development in endovascular aortic repair (EVAR) and TEVAR, and as the products evolve, there will be continued growth in this market. Unmet Needs Remain a Challenge The complications in endovascular repair usually occur during or immediately after the procedure, which must be treated immediately through either interventional or open surgery methods. Endoleaks are the most common complication and area of focus; the remaining complications, such as paraplegia, infection, and limb thrombosis, amongst others, occur from time to time and knowledge of them can help enhance future product design. Technological challenges also pose an opportunity for the development of better products with better clinical outcomes. The availability of lower profile systems will continue to improve accessibility. Customized fenestrated stent grafts will allow more complicated aneurysms to be treated, thereby enhancing the potential patient pool. Multibranched systems will also allow for more tortuous anatomy to be treated. Finally, addressing the need for more long-term clinical data will allow more surgeons to be comfortable implanting stent grafts, with the assurance of durability in younger patients. Key Players in the Aortic Stent Graft Market At present, the aortic stent grafts market is still dominated by the top three players: Cook Medical, Gore Medical, and Medtronic. The products that are currently approved and on the market are all of high quality and each have their strengths with fixation types. The products in development by those outside of the top three players are all innovative in their own way, but a product that will show superior benefits with a lower or at least equal cost will be the one to grow the most. The most talked about emerging player in the market, based on GlobalData s key opinion leaders (KOLs), is Endologix. Endologix has one of the strongest product pipelines with significantly new product features and a new approach to treatment that has the potential to grab a piece of market share. The next one to three years will determine the quality of the potential products for Endologix, 4

5 Executive Summary based on approval and clinical trials. In the EU, the top 82% of the EVAR market and top 92% in TEVAR market belongs to the three companies mentioned earlier. The ongoing trend in the aortic stent grafts market is that the leading players will continue to maintain market share, unless a disruptive technology in this segment dramatically changes clinical outcomes. Aortic Stent Graft Market Future Outlook The economic downturn has been a source of continued concern for high priced medical devices across the global market. The aortic stent grafts market is not one that is excluded from this trend. Despite the high product price, physicians still see a significant benefit in providing endovascular options versus performing open surgery. As physician education improves and they have access to more clinical trial data, the outlook for the aortic stent grafts looks strong with there being much room for product improvement. The market outlook looks strong in the Western markets, as there is still much room for product adoption and growth. Regionally, one can expect slightly different drivers for growth.. In some countries, the EU market is still restricted by cost, thereby making physicians choose their patients carefully before implantation of the device. The aortic stent grafts market is a moderately growing market at a CAGR of 6.7% in EU, with some individual markets boasting a stronger CAGR over others. Within the 5EU, it is the cardiovascular sector that is expected to continue to grow the most in response to the continual technological developments and physicians acceptance of the products successful clinical performance. The EU market is based on, and will be driven by, the rising prevalence of aortic aneurysms and the aging population. GlobalData expects continued growth in this niche market with the major deterrent, globally, to be product price once a product is accepted by a surgeon. What Do Physicians Think? Physicians expect the cost of implants to be a growing concern for practices and hospitals. Cost is a major issue all across the board, specifically here. We try to do everything with the least cost possible. So, if the grafts are exactly the same and treat the same problem, then we try to use the graft that's cheaper. Key Opinion Leader In an economic downturn, we need to be able to show that what we do is cost-effective. Many hospitals, for example, have capped down the number of procedures that can be done in a year. Key Opinion Leader 5

6 Executive Summary With regard to the technological trends and product enhancement expectations, KOLs speak on what is needed the most today. Smaller sheath size, introduction diameter. And the reason being, is that a major limitation is the size of the external iliac arteries, disease there, not allowing you to pass the stent graft up. Lowerprofile delivery devices, which are also in trial. Actually, they're not on trial. For many companies, they're brand-new. Key Opinion Leader Physicians discuss government regulations where reimbursement plays a big part in choosing to do endovascular repair procedures. We use the product we think we need. The expensive price is limiting our activity, of course. So, we have to choose the product by indication. So, we cannot use these products. More patients; [we] have to select the best patients to use on this because of the price, sure. Key Opinion Leader Physicians are interested in solid clinical studies to prove outcomes in products. In all honesty, the specific product features don't matter as much as the trials that show whether a device is durable or not. Everyone has their little, We have a hook here, and other people have the supra-aortic stents. We have ones with hooks, ones without hooks. We have screws that go into the aortic wall. The reality is, unless there's some sort of published data, everything else is just theoretical. And to me, that doesn't matter. Key Opinion Leader Physicians talk about the shift from open surgery to endovascular repair. In the smaller hospitals where you have older surgeons who didn't have endovascular training, those are the ones who need more experience with the devices than people like myself, who've been out about four or five years. Key Opinion Leader [The] endovascular device, we would use that almost exclusively, except in super young patients. Patients less than 60, we offer an open operation just because it's durable. Technically speaking, you're fixing the problem both ways. It's just that we know that open will last 30, 40 years. We still don't know that about endovascular. Key Opinion Leader 6

7 List of Tables List of Figures Introduction Catalyst Related Reports Upcoming Related Reports Industry Overview Overview Indications Aortic Abdominal Aneurysm Thoracic Aortic Aneurysm Aortic Dissection Clinical Outcomes Lifestyle Changes Medication Open Surgery Endovascular Repair Procedure Trends EU Market Access

8 3.5.1 Adoption Regulation Reimbursement Regulatory Issues/Recalls Anaconda Back on the Market in March 2014 after a Voluntary Recall of Anaconda by Vascutek Terminated FDA s Class II Recall of TriVascular s Ovation Prime in April Mergers, Deals, and Acquisitions Medtronic Acquires Covidien TriVascular Launches $100m Initial Public Offering Lombard Medical Pursues US Initial Public Offering TriVascular Raises $40m in Series E Financing LifeTech Scientific Creates Partnership with Medtronic LeMaitre Vascular Terminates Distribution Agreement with Endologix Jotec Enters Licensing Agreement with Hydromer Endologix Public Offering of Notes Aptus Endosystems Secures Financing Altura Medical Secures Financing Endologix Acquires Nellix Endovascular Economic Impact Economic Impact of Aneurysms Treatment Costs of Aortic Aneurysms Unmet Needs

9 4.1 Addressing the Complications Endoleaks Ischemic Complications Limb Thrombosis Infection Paraplegia in Thoracic Aortic Aneurysm The Seal and Landing Zone Short Neck Cost Containment More Low Profile Systems Customized Fenestrated Stent Grafts Multi-Branch Stent Grafts Thoracic Endovascular Aneurysm Repair Unmet Needs Long-Term Clinical Data Market Opportunity Analysis Emerging Markets Thoracic Aortic Disease Market Addition of Physician Training Programs Disruptive Technologies Minimally Invasive Trend Market Drivers, Barriers, and Substitutes Driver: Rising Disease Prevalence Diabetes Mellitus

10 6.1.2 Hypertension Obesity Tobacco Use Driver: Aging Driver: Imaging Driver: Improved Clinical Outcomes with Endovascular Therapy Driver: Time Savings Driver: Patient Demand and Awareness Driver: Technological Developments Custom Branched and Fenestrated Stent Grafts Low Profile Delivery Systems Driver: Rising Competition and Innovation Barrier: Availability of Venture Capital Barrier: Burden of Rising Regulation Barrier: High Treatment Cost Barrier: Proving Long-Term Efficacy Barrier: High Radiation Dosages with Excessive Imaging Surgical Limitations Barrier: Medical Device Excise Tax Substitute: Open Surgery Substitute: Chimney Technique versus Fenestrated Grafts Competitive Assessment Overview

11 7.2 Key Marketed Products Endovascular Aneurysm Repair and Thoracic Endovascular Aneurysm Repair Products Pipeline Assessment Overview Product Profiles Altura Medical Endograft Cordis INCRAFT EndoSpan Horizon EndoSpan Nexus MicroPort Scientific Castor Branched Stent Graft System BiFlow Medical Novel Side-Branch Stent Endoluminal Sciences Endograft Mechanism Medtronic Valiant Mona LSA Stent Graft System Endologix Ventana Fenestrated Stent Graft Clinical Trials to Watch Overview Altura Medical Cook Medical Gore Medical Terumo Corporation Endologix TriVascular

12 9.8 Bolton Medical Medtronic Cordis Corporation Current and Future Players Overview Trends in Corporate Strategy Company Profiles Cook Medical Endologix Gore Medical Medtronic Terumo Corporation Altura Medical Aptus Endosystems Bolton Medical Braile Biomédica B. Braun Cardiatis LeMaitre Vascular Lifetech Scientific Getinge Group Grikin Advanced Materials Johnson & Johnson s Cordis Corporation

13 Jotec Lombard Medical MicroPort Scientific Corporation Nano Endoluminal TriVascular Weike Medical Apparatus and Instrument YTH Biological Material Scitech Market Outlook Company Market Share By Market Segment Overview Endovascular Aneurysm Repair Thoracic Endovascular Aneurysm Repair By Geography EU Overview EU Appendix Bibliography Abbreviations Research Methodology Overview Coverage Secondary Research

14 12.4 Physicians and Specialists Included in this Study Christopher Abularrage, MD, FACS Gaspar Mestres Alomar, MD Enio Buffolo, MD, PhD Ludovic Canaud, MD, PhD Holger Eggebrecht, MD Daisuke Fukui, MD, PhD Germano Melissano, MD Dr. Raghuram Sekhar MS, FRCS (Edinburgh), FRCS (Glasgow) Ferdinand Serracino-Inglott, MD, MSc, FRCSI, FRCS (Gen Surg), DIC Jiang Xiong, MD, PhD Primary Research Primary Research Key Opinion Leader Interviews Primary Research Physician and Industry Interviews Expert Panel Validation Forecasting Methodology About the Authors Analysts Global Head of Healthcare About MediPoint About GlobalData Disclaimer

15 1.1 List of Tables Table 1: Summary of Indications, Symptoms, and Treatments Table 2: Thoracic Aortic Aneurysm Types Table 3: Medications for Reducing Risk of Aneurysm Growth and Rupture Table 4: Advantages and Disadvantages of Open Repair versus Endovascular Repair Table 5: Group Purchasing Organizations in the EU Table 6: Regulatory Differences between the US and EU Table 7: Direct and Indirect Costs of Open Surgery and Endovascular Repair Table 8: Comparison Costs and Other Variables for Treating AAA By Open Repair and Stent Grafts in 2012 ($US) Table 9: Endoleak Types Table 10: Zenith Family Marketed Products Table 11: Zenith AAA SWOT Table 12: Zenith TAA SWOT Table 13: Endologix s Marketed Products Table 14: AFX Endovascular SWOT Table 15: IntuiTrak Powerlink System SWOT Table 16: Gore Medical s Marketed Products Table 17: Gore AAA Product SWOT Table 18: Gore TAA Product SWOT Table 19: Medtronic s Marketed Products Table 20: Medtronic AAA Product SWOT Table 21: Medtronic TAA Product SWOT Table 22: Terumo Corporation Marketed Products

16 able 23: Terumo Corporation AAA Product SWOT Table 24: SWOT Analysis Altura Medical Endograft Table 25: SWOT Analysis Cordis INCRAFT Table 26: SWOT Analysis EndoSpan Horizon Table 27: SWOT Analysis EndoSpan Nexus Table 28: SWOT Analysis MicroPort Scientific Castor Branched Stent Graft System Table 29: SWOT Analysis BiFlow Medical Novel Side-Branch Stent Table 30: SWOT Analysis Endoluminal Sciences Endograft Mechanism Table 31: SWOT Analysis Medtronic Valiant Mona LSA Stent Graft Table 32: SWOT Analysis Endologix Ventana Fenestrated Stent Graft Table 33: Major Clinical Trials of Altura Medical s Aortic Stent Grafts Table 34: Major Clinical Trials of Cook Medical s Aortic Stent Grafts Table 35: Major Clinical Trials of Gore Medical s Aortic Stent Grafts Table 36: Major Clinical Trials of Terumo s Aortic Stent Grafts Table 37: Major Clinical Trials of Endologix s Aortic Stent Grafts Table 38: Major Clinical Trials of TriVascular s Aortic Stent Grafts Table 39: Major Clinical Trials of Bolton Medical s Aortic Stent Grafts Table 40: Major Clinical Trials of Medtronic s Aortic Stent Grafts Table 41: Major Clinical Trials of Cordis Aortic Stent Grafts Table 42: Company Profile Cook Medical Table 43: Cook Medical Marketed Products Table 44: SWOT Analysis Cook Medical Table 45: Company Profile Endologix Inc Table 46: Endologix Marketed Products

17 Table 47: Endologix Pipeline Products Table 48: SWOT Analysis Endologix Inc Table 49: Company Profile Gore Medical Table 50: Gore Medical Marketed Products Table 51: SWOT Analysis Gore Medical Table 52: Company Profile Medtronic Table 53: Medtronic Marketed Products Table 54: SWOT Analysis Medtronic Table 55: Company Profile Terumo Corporation Table 56:Terumo Corporation Marketed Products Table 57: SWOT Analysis Terumo Corporation Table 58: Company Profile Altura Medical Inc Table 59: Altura Medical Inc. Marketed Products Table 60: SWOT Analysis Altura Medical Inc Table 61: Company Profile Aptus Endosystems, Inc Table 62: Aptus Endosystems Inc. Marketed Products Table 63: SWOT Analysis Aptus Endosystems Inc Table 64: Company Profile Bolton Medical Table 65: Bolton Medical Marketed Products Table 66: SWOT Analysis Bolton Medical Table 67: Company Profile Braile Biomédica Table 68: Braile Biomédica Marketed Products Table 69: SWOT Analysis Braile Biomédica Table 70: Company Profile B. Braun

18 Table 71: B. Braun Marketed Products Table 72: SWOT Analysis B. Braun Table 73: Company Profile Cardiatis Table 74: Cardiatis Marketed Products Table 75: SWOT Analysis Cardiatis Table 76: Company Profile LeMaitre Vascular Table 77: LeMaitre Vascular Medical Marketed Products Table 78: SWOT Analysis LeMaitre Vascular Table 79: Company Profile Lifetech Scientific Table 80: Lifetech Scientific Marketed Products Table 81: SWOT Analysis Lifetech Scientific Table 82: Company Profile Getinge Group Table 83: Getinge Group Marketed Products Table 84: SWOT Analysis Getinge Group Table 85: Company Profile Grikin Advanced Materials Table 86: Grikin Advanced Materials Marketed Products Table 87: SWOT Analysis Grikin Advanced Materials Table 88: Company Profile Johnson & Johnson Cordis Corporation Table 89: Cordis Corporation s Pipeline Product Table 90: SWOT Analysis Cordis Corporation Table 91: Company Profile Jotec Table 92: Jotec s Marketed Products Table 93: SWOT Analysis Jotec Table 94: Company Profile Lombard Medical

19 Table 95: Lombard Medical Marketed Products Table 96: SWOT Analysis Lombard Medical Table 97: Company Profile Microport Scientific Corporation Table 98: MicroPort Scientific Marketed Products Table 99: SWOT Analysis MicroPort Scientific Table 100: Company Profile Nano Endoluminal Table 101: Nano Endoluminal Medical Marketed Products Table 102: SWOT Analysis Nano Endoluminal Table 103: Company Profile TriVascular Table 104: TriVascular Marketed Products Table 105: SWOT Analysis TriVascular Table 106: 5EU Aortic Stent Grafts Sales ($m) Forecast, by Segment, Table 107: 5EU Aortic Stent Grafts Sales ($m) Forecast, EVAR, Table 108: 5EU Aortic Stent Grafts Sales ($m) Forecast, TEVAR, Table 109: Aortic Stent Grafts Sales ($m) for the 5EU, Table 110: Aortic Stent Grafts Sales ($m) Forecast for the 5EU, Table 111: Aortic Stent Grafts Sales ($m) Forecast for France, Table 112: Aortic Stent Grafts Sales ($m) Forecast for Germany, Table 113: Aortic Stent Grafts Sales ($m) Forecast for Italy, Table 114: Aortic Stent Grafts ($m) Forecast for Spain, Table 115: Aortic Stent Grafts Sales ($m) Forecast for the UK,

20 1.2 List of Figures Figure 1: Treatment Methodology Markov Model Figure 2: Aortic Stent Graft Product Image Figure 3: EU Abdominal Aortic Stent Grafts Procedure Volume, Figure 4: EU Thoracic Aortic Stent Grafts Procedure Volume, Figure 5: EU Market Share for EVAR, Figure 6: EU Market Share for TEVAR, Figure 7: 5EU Aortic Stent Grafts Sales ($m) Forecast, by Segment, Figure 8: 5EU Aortic Stent Grafts Sales ($m) Forecast, EVAR, Figure 9: 5EU Aortic Stent Grafts Sales ($m) Forecast, TEVAR, Figure 10: Aortic Stent Grafts Sales ($m) for 5EU, Figure 11: Aortic Stent Grafts by Major Market, 2013 and Figure 12: 5EU Sales ($m) Forecast for Aortic Stent Grafts, Figure 13: France Sales ($m) Forecast for Aortic Stent Grafts, Figure 14: Germany Sales ($m) Forecast for Aortic Stent Grafts, Figure 15: Italy Sales ($m) Forecast for Aortic Stent Grafts, Figure 16: Spain Sales ($m) Forecast for Aortic Stent Grafts, Figure 17: UK Sales ($m) Forecast for Aortic Stent Grafts, Figure 18: Aortic Stent Graft Primary Research, Supply and Demand-Side Interviews

21 Introduction 2 Introduction Aortic stent grafts are most commonly used to reinforce a weak spot in an artery, which is known as an aneurysm. The stent grafts are designed to seal tightly with the patient s native artery above and below the aneurysm, and are used to treat abdominal aortic aneurysms (AAAs) as well as thoracic aortic aneurysms (TAAs). Aortic aneurysms, as opposed to aneurysms found elsewhere in the body, are potentially very serious, as a burst aorta results in massive internal bleeding that can be fatal unless treated rapidly by an experienced emergency medical team. Since their introduction in patients in 1991, aortic stent graft devices have gained wide acceptance and availability, with their adoption fueled in great part by advances in stent-graft design and by a variety of devices for various anatomic features. Over time, these devices have gained traction for use in patients with ruptured aneurysms because they are minimally invasive and have shorter recovery times. Based on GlobalData s key opinion leader (KOL) research, in the more mature Western markets, about 80% of surgical treatments for aneurysms are treated through endovascular therapy. The remaining market is treated by open surgical options. This surgical rate is reduced further in the emerging nations, due to the high product cost. While endovascular therapy has its clear benefits, there are strong arguments still being made both clinically, and from a cost perspective, to continue doing open surgery. Overall, this minimally invasive endovascular technique saves hospitalization costs in the short run while it continues to bring in revenue for hospitals and practices, as several more of these cases can be scheduled in a day, with shorter surgical times. From a clinical standpoint, there are a multitude of clinical trials in progress as the stent grafts and their delivery systems are trending towards lower and lower profile systems, thereby allowing the products to be used on a wider patient population that previously, was treatable only through open techniques. Overall, GlobalData expects the procedural data to continue to grow across the European major markets (5EU) (France, Germany, Italy, Spain and UK,), with the greatest opportunity being in the emerging nations. This report focuses on the aortic stent graft implant market for abdominal and TAAs. The abdominal aortic market comprises about 80 90% of the market, with the niche market being the thoracic one. The thoracic aneurysm repair market is still a young market where there is a strong pipeline of products from both the large manufacturers and small emerging players. For most manufacturers, following the successful launch of an AAA product, the thoracic stent graft segment presents the opportunity with the most unmet needs for pursuit. 21

22 Introduction The 5EU are covered and forecast in this report, which provides the unmet needs, future adoption, and Compound Annual Growth Rates (CAGRs) in both the abdominal stent graft and thoracic stent graft markets. GlobalData s analysis demonstrates this market to be a young and growing market, subject to rapid technological development and with much room for product adoption. 2.1 Catalyst Increasing the applicability of aortic stent grafts to patients with difficult anatomic features will likewise require improvements as well as innovation in device design. Currently, the three most common anatomic reasons for exclusion from the endovascular repair of AAAs are inappropriate aortic (proximal) neck access, iliac artery aneurysms, and inadequate iliac access. Researchers have noted that the next frontier for aortic stent grafts will be the continued adoption and development of endografts that are capable of treating various types of aortic aneurysms for a number of different patient anatomies. Further, in order to avoid follow-up on patients with implanted devices, future aortic stent graft products will have increased durability, refined designs to allow for treatment in the most difficult anatomies, and advanced abilities to treat aneurysms involving the renal and visceral segments of the aorta. There are significant opportunities remaining for companies that can develop slimmer devices with reduced sheath diameter, improve the fixation of grafts, or add additional features including branches or fenestrated necks. Currently, some of the most frequently encountered barriers for aortic stent graft use consist of an inadequate or inappropriate proximal neck anatomy and an inadequate caliber of iliofemoral access vessels. As such, the ability of devices to accommodate patients with difficult necks or treacherous access vessels is important. That said, novel bifurcated endografts along with the development of widely available branched and fenestrated grafts are expected to address these barriers, thereby improving upon the already remarkable clinical Currently, some of the most frequently encountered barriers for aortic stent graft use consist of an inadequate or inappropriate proximal neck anatomy and an inadequate caliber of iliofemoral access vessels. success of this procedure. This report looks at the current aortic stent grafts market for cardiovascular disease and evaluates the adoption and opportunities for this technology in the 5EU. In the 5EU region, this market is expected to rise from $288 million in 2014 to $445 million in 2020, at a CAGR of 6.4%. 22

23 Introduction 2.2 Related Reports GlobalData (2012). Bioabsorbable Stents Global Market Analysis and Forecasts, December 2012, GDME0164MAR GlobalData (2012). Peripheral Vascular Stents Global Market Analysis and Forecasts, April 2012, GDME0168MAR GlobalData (2013). Drug Eluting Balloons Global Market Analysis and Forecasts, September 2013, GDME0179MAR GlobalData (2014). Neurovascular Interventions Global Market Analysis and Forecasts April 2014, GDME0194MAR 2.3 Upcoming Related Reports GlobalData (2014). Coronary Stents Global Market Analysis and Forecast, to be published 23

24 Appendix 12.8 About MediPoint MediPoint is the flagship product for GlobalData s Medical team. Each MediPoint report is built from the ground up by our team of healthcare analysts in the US and UK. Each report includes input from experienced physicians and leading Key Opinion Leaders (KOLs). Running throughout each report in the series are, What Do Physicians Think quotes, which provide a unique insight into how healthcare professionals are reacting to events within the industry, and what their responses could mean for industry strategists About GlobalData GlobalData is a leading global provider of business intelligence in the healthcare industry. GlobalData provides its clients with up-to-date information and analysis on the latest developments in drug research, disease analysis, and clinical research and development. Our integrated business intelligence solutions include a range of interactive online databases, analytical tools, reports, and forecasts. Our analysis is supported by a 24/7 client support and analyst team. GlobalData has offices in New York, San Francisco, Boston, London, India, Korea, Japan, Singapore, and Australia Disclaimer All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of the publisher, GlobalData. 208

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