Japan Vascular Surgery and Endovascular Procedures Market, 2026-2035

Market Overview

The Japan vascular surgery and endovascular procedures market was valued at USD 142.26 million in 2025 and is projected to reach USD 309.98 million by 2035, expanding at an 8.1% CAGR during 2026-2035. The market covers procedure-related vascular devices and supplies used in peripheral arterial, aortic, venous, dialysis-access and other vascular interventions performed through open surgical or endovascular techniques.

Japan's market is moving toward minimally invasive treatment, but the transition is not uniform. Endovascular therapy is expanding rapidly for extremity arterial disease and aortic repair, while open bypass, endarterectomy and graft reconstruction remain essential for complex anatomy, infected fields, younger patients and cases in which durable surgical repair is preferred. The 2024 National Clinical Database registered 223,422 peripheral vascular procedures, including 59,899 endovascular treatments for extremity arteries, up from 54,798 in 2023.

Key Highlights

• 2025 market value: USD 142.26 million
• 2035 forecast: USD 309.98 million
• Forecast CAGR: 8.1% during 2026-2035
• Largest procedure category: Endovascular procedures, 72.0% or USD 102.43 million
• Largest device category: Stents and stent grafts, 31.0% or USD 44.10 million
• Largest disease segment: Peripheral arterial disease, 36.0% or USD 51.21 million
• Largest end user: Hospitals and university medical centers, 78.0% or USD 110.96 million
• 2024 registered peripheral vascular procedures: 223,422
• 2024 extremity-artery endovascular procedures: 59,899

Market Definition and Scope

Vascular surgery treats diseases of arteries, veins and access circuits outside the heart. Open procedures include bypass grafting, surgical thrombectomy, endarterectomy, aneurysm replacement, fistula creation and vascular reconstruction. Endovascular procedures include angioplasty, stent or stent-graft placement, drug-coated balloon treatment, atherectomy, mechanical thrombectomy, embolization and endovenous ablation.

Revenue includes balloons, stents, stent grafts, catheters, guidewires, thrombectomy systems, vascular grafts, closure and hemostasis products and other consumables directly tied to the procedure. The value of hospital stays, physician fees, imaging capital equipment and coronary or neurovascular procedures is excluded unless specifically part of a peripheral or aortic vascular intervention.

Procedure-Volume Context

Japan's National Clinical Database recorded 111,104 arterial procedures in 2024, 36,657 venous procedures, 30,817 procedures involving other vascular systems and 44,844 other peripheral vascular surgeries. Endovascular treatment for extremity arteries was the single largest named procedure at 59,899 cases. Endovenous ablation for lower-extremity varicose veins ranked second at 28,569, followed by arteriovenous fistula creation at 21,311.

The data show two simultaneous trends. Extremity endovascular treatment increased by more than 5,000 cases in one year, while varicose-vein ablation and fistula creation declined. Market growth therefore cannot be estimated by applying one rate across every procedure. Revenue is increasingly concentrated in complex arterial devices, aortic stent grafts, drug-coated technology and thrombectomy.

Market Dynamics

Peripheral intervention is the main volume-growth engine

Japan's aging population, diabetes, chronic kidney disease and smoking history contribute to peripheral arterial disease. Endovascular therapy offers lower procedural trauma and shorter recovery than open bypass for many patients. The largest growth is occurring in femoropopliteal and below-the-knee treatment, where calcification, long lesions and restenosis create demand for balloons, drug-coated devices, stents and thrombectomy.

Thrombus management is moving beyond balloon-only workflows

BD's Rotarex system received Japanese approval in July 2026, obtained reimbursement from October 1 and was used clinically in Japan for the first time that day. The system combines rotational fragmentation and aspiration for thrombotic lesions associated with atherosclerosis in lower-extremity arteries. Its arrival adds a mechanical option for acute and organized thrombus and can reduce the need to rely solely on aspiration, lysis or surgery.

Drug-coated balloons are becoming more differentiated

Japan now includes paclitaxel-coated and sirolimus-eluting peripheral balloon options. Cordis launched SELUTION SLR in April 2026, citing three-year Japan trial results of 81.5% primary patency and 93.8% freedom from reintervention. Boston Scientific's Ranger platform uses paclitaxel and received a 2026 PMDA-reviewed change. Selection will increasingly depend on lesion type, clinical evidence, drug-delivery profile and reimbursement rather than a generic drug-coated-balloon category.

Branched aortic systems are expanding treatable anatomy

Complex arch and thoracoabdominal aneurysms have historically required open repair, debranching or physician-modified devices in high-risk patients. Gore began reimbursed use of its thoracoabdominal branch endoprosthesis in May 2026 and expanded insurance coverage for TAG thoracic branch configurations in September. Branched systems can extend endovascular repair but require advanced imaging, planning, inventory and operator training.

Hospital concentration supports complex technology adoption

Advanced aortic and limb-salvage procedures are concentrated in university hospitals and high-volume cardiovascular centers. This supports specialist training and outcomes tracking but limits rapid diffusion to smaller hospitals. Manufacturers need proctoring, case planning and inventory support, especially for branched grafts and thrombectomy systems.

Reimbursement timing determines commercial uptake

PMDA approval permits marketing, but reimbursement listing determines routine funded use. Product launch plans must align regulatory approval, reimbursement, physician training and hospital purchasing. Rotarex's first domestic case coinciding with reimbursement illustrates how quickly use can begin when these steps are coordinated.

Open surgery remains strategically important

Endovascular growth does not eliminate open procedures. Bypass, graft replacement and surgical thrombectomy remain necessary for infection, failed prior intervention, unsuitable access or anatomy and selected durability requirements. Hybrid operating rooms allow open exposure and endovascular treatment within one procedure, creating demand across both device classes.

Market Segmentation

By Procedure Type

Endovascular procedures held 72.0% of 2025 market revenue, equal to USD 102.43 million. Angioplasty, stenting, stent-graft repair, thrombectomy, embolization and endovenous ablation support leadership. High-value implants and repeat interventions increase revenue share beyond procedure-count share.

Open vascular surgery represented 28.0%, or USD 39.83 million. Bypass grafting, aneurysm replacement, endarterectomy, open thrombectomy and access surgery remain clinically essential. Its share will decline gradually, but complex repair and hybrid procedures support absolute demand.

By Product Type

Stents and stent grafts held 31.0% of 2025 revenue, equal to USD 44.10 million. Aortic, iliac, femoropopliteal and dialysis-access applications contribute. Branched grafts raise the value per case.

Angioplasty and drug-coated balloons represented 23.0%, or USD 32.72 million. Plain, scoring, specialty and drug-coated balloons support lesion preparation and therapy across arterial territories.

Catheters and delivery systems accounted for 14.0%, equal to USD 19.92 million. Diagnostic, support, aspiration, crossing and delivery catheters are included.

Guidewires and access devices held 10.0%, or USD 14.23 million. Complex chronic total occlusions and distal intervention require specialized support and crossing performance.

By Disease and Indication

Peripheral arterial disease held 36.0% of 2025 revenue, equal to USD 51.21 million. Extremity endovascular volume and limb-salvage demand support leadership.

Aortic aneurysm and dissection represented 27.0%, or USD 38.41 million. EVAR, TEVAR, branched systems and open graft replacement contribute high device value.

Varicose veins and chronic venous disease accounted for 17.0%, equal to USD 24.18 million. Ablation volume remains high despite the 2024 decline.

Dialysis-access creation and maintenance held 10.0%, or USD 14.23 million. Japan's dialysis population supports recurring fistula, graft and access-circuit intervention.

Carotid and other extracranial vascular disease represented 5.0%, or USD 7.11 million, while trauma, visceral disease and other indications formed 5.0%, or USD 7.11 million.

By End User

Hospitals and university medical centers held 78.0% of 2025 revenue, equal to USD 110.96 million. Specialized cardiovascular and vascular clinics represented 14.0%, or USD 19.92 million. Ambulatory centers and other facilities accounted for 8.0%, or USD 11.38 million. Complex aortic, thrombectomy and hybrid procedures will remain concentrated in hospitals.

Competitive Landscape

The market includes Japanese manufacturers, multinational vascular-device companies and specialist graft suppliers. Relevant participants include Terumo, Medtronic, Boston Scientific, BD/Medicon, W. L. Gore, Cordis, Nipro and Cook Medical. Competitive advantage depends on clinical evidence, PMDA approval, reimbursement, device range, local training and case support.

Terumo Corporation

Terumo has a broad interventional portfolio spanning guidewires, catheters, access and hemostasis products. Its Japanese distribution and physician relationships provide strong access to vascular centers. In May 2026, Terumo launched TR Band Distal for hemostasis after distal radial access procedures. The product supports a wider shift toward alternative access sites and entry-site management, with transparent positioning and pressure adjustment designed to simplify post-procedure care.

Medtronic

Medtronic supplies aortic stent grafts, peripheral vascular technologies and related delivery systems. PMDA approved a partial change for the Valiant Thoracic Stent Graft System on June 8, 2026, based on review of an improved device with clinical data. Medtronic's advantage lies in an established aortic portfolio and clinical support. Commercial expansion depends on matching approved configurations to Japanese anatomy, reimbursement and center experience.

Boston Scientific

Boston Scientific's peripheral portfolio includes Ranger drug-coated balloons, Eluvia drug-eluting stents, Innova stents, Jetstream atherectomy and other access and embolic technologies. PMDA's June 17, 2026 review entry for the Ranger catheter reflects continued lifecycle development. The company's position spans lesion preparation, drug delivery and vessel scaffolding, enabling procedure-level portfolio selling.

BD and Medicon

BD's Japanese group company Medicon markets vascular-access and peripheral-intervention products. Rotarex adds a differentiated mechanical thrombectomy platform combining fragmentation and aspiration for lower-extremity thrombotic lesions. Approval in July, reimbursement in October and the first clinical use on October 1 demonstrate a coordinated launch. Adoption will depend on training, lesion selection and evidence from Japanese use.

Recent Developments

• October 2026 - BD/Medicon: Announced Japan's first clinical use of Rotarex at Osaka Keisatsu Hospital; the procedure occurred on October 1, when reimbursement also began.
• September 2026 - W. L. Gore: Began reimbursed sale of TAG Thoracic Branch Endoprosthesis configurations for Zone 0 and Zone 1 aortic-arch treatment.
• July 2026 - BD/Medicon: Announced Japanese marketing approval for Rotarex, the country's first combined rotational-fragmentation and aspiration thrombectomy device for specified lower-extremity arterial lesions.
• July 2026 - W. L. Gore: Began insurance-covered use of the VIATORR controlled-expansion TIPS stent graft and related set in Japan.
• June 2026 - Boston Scientific Japan: PMDA recorded approval-related review activity for the Ranger drug-coated balloon catheter.
• June 2026 - Medtronic Japan: Received approval for a partial change to the Valiant Thoracic Stent Graft System following PMDA review with clinical data.
• May 2026 - Terumo: Launched TR Band Distal in Japan for hemostasis following distal radial artery access procedures.
• May 2026 - W. L. Gore: Announced insurance listing and the first Japanese case using the EXCLUDER thoracoabdominal branch endoprosthesis.

Strategic Key Takeaways

• Extremity endovascular treatment is the clearest volume-growth segment. Registered cases increased by more than 5,000 in 2024.
• Aortic growth is moving toward branched anatomy. New graft configurations expand treatment for patients previously requiring open or customized approaches.
• Thrombectomy is becoming a distinct device category. Rotarex introduces combined fragmentation and aspiration into Japanese lower-limb practice.
• Drug-coated balloon competition is shifting from class-level adoption to platform differentiation. Drug, dose, release profile and long-term patency evidence will shape selection.
• Reimbursement timing controls launch velocity. Regulatory approval alone does not create routine hospital demand.
• Kanto and Kansai will remain the primary entry markets for complex products. High-volume centers provide training, evidence and referral concentration.
• Open surgery will remain essential despite endovascular share gains. Hybrid capability and durable reconstruction preserve demand for surgical grafts and instruments.

Japan Vascular Surgery and Endovascular Procedures Market Scope

The Japan vascular surgery and endovascular procedures market report delivers a detailed analysis with 39 key tables, more than 31 visually impactful figures, and 147 pages of expert insights, providing a complete view of the market landscape.