<PAGE>

                                 EXHIBIT 10.33.1

                       SECOND AMENDMENT TO LOAN AGREEMENT
                       ----------------------------------

     THIS SECOND AMENDMENT TO LOAN AGREEMENT (the "Second Amendment") made and
entered into as of June 30, 2003, by and among WACHOVIA BANK, NATIONAL
ASSOCIATION (f/k/a FIRST UNION NATIONAL BANK), a national banking association,
WACHOVIA BANK, NATIONAL ASSOCIATION, LONDON BRANCH (f/k/a FIRST UNION NATIONAL
BANK, LONDON BRANCH), a national banking association acting through its London
Branch, ARROW INTERNATIONAL, INC., a Pennsylvania corporation, ARROW MEDICAL
PRODUCTS, LTD., a Pennsylvania corporation authorized to engage in business in
Canada, ARROW DEUTSCHLAND GMBH, a corporation organized and existing under the
laws of Germany, ARROW IBERIA, S.A., a corporation organized and existing under
the laws of Spain, ARROW INTERNACIONAL DE MEXICO S.A. DE C.V., a corporation
organized and existing under the laws of Mexico, ARROW HELLAS COMMERCIAL A. E.,
a corporation organized and existing under the laws of Greece, ARROW HOLLAND
MEDICAL PRODUCTS B.V., a corporation organized and existing under the laws of
Holland, ARROW INTERNATIONAL CR, A.S., a corporation organized and existing
under the laws of the Czech Republic, and ARROW ITALY S.R.L., a corporation
organized and existing under the laws of Italy.

BACKGROUND
----------

          A.   The Lender and the Borrowers are parties to a loan agreement
dated April 12, 2001, as amended March 29, 2002, pursuant to which the Lender
agreed to provide the Borrowers with Loans in an aggregate outstanding amount
not to exceed at any one time Sixty-Five Million Dollars ($65,000,000), subject
to and in accordance with the terms and conditions set forth therein (the
"Agreement").

          B.   The Agreement is incorporated by reference in this Second
Amendment. Capitalized terms used herein which are not so defined, but which are
defined in the Agreement, shall have the meanings given such terms in the
Agreement.

          C.   At the Borrowers' request, the Lender has agreed to extend the
Termination Date under the Agreement, as hereinafter set forth.

                                    AGREEMENT
                                    ---------

          NOW, THEREFORE, in consideration of the mutual promises contained
herein and intending to be legally bound hereby, the parties hereto covenant and
agree as set forth below.

          1.   INCORPORATION OF BACKGROUND. The Background provisions of this
Second Amendment are incorporated herein by reference thereto as if fully set
forth in this Second Amendment.

          2.   AMENDED DEFINED TERMS. The following defined terms as set forth
in Section 1.2 of the Agreement are hereby amended and restated in their
entirety to read as follows:

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               "AGREEMENT" shall mean the Loan Agreement among the Lender and
     the Borrowers dated April 12, 2001, as amended by the Lender and the
     Borrowers pursuant to the First Amendment to Loan Agreement dated as of
     March 29, 2002, as further amended by the Lender and the Borrowers pursuant
     to the Second Amendment to Loan Agreement dated as of June 30, 2003, and
     any future amendments, restatements, modifications or supplements thereof
     or thereto.

               "BORROWER" shall mean each of Arrow International, Inc., a
     Pennsylvania corporation, Arrow Medical Products, Ltd., a Pennsylvania
     corporation authorized to engage in business in Canada, Arrow Deutschland
     GmbH, a corporation organized and existing under the laws of Germany, Arrow
     Iberia, S.A., a corporation organized and existing under the laws of Spain,
     Arrow Internacional De Mexico, S.A. de C.V., a corporation organized and
     existing under the laws of Mexico, Arrow Hellas Commercial A. E., a
     corporation organized and existing under the laws of Greece, Arrow Holland
     Medical Products B.V., a corporation organized and existing under the laws
     of Holland, Arrow International CR, a.s., a corporation organized and
     existing under the laws of the Czech Republic, and Arrow Italy S.r.l., a
     corporation organized and existing of the laws of Italy, and "Borrowers"
     shall mean any two or more of them.

               "TERMINATION DATE" shall mean April 30, 2004 or, if such day is
     not a Business Day, the next succeeding Business Day, unless such Business
     Day falls in another calendar month, in which case the Termination Date
     shall be the next preceding Business Day.

               "DEBT" shall mean, with respect to any Person at any applicable
     time (without duplication), (i) all obligations of such Person for borrowed
     money, (ii) all obligations of such Person evidenced by bonds, debentures,
     notes or similar instruments, (iii) all obligations of such Person under
     conditional sale or other title retention agreements relating to property
     purchased by such Person to the extent of the value of such property (other
     than customary reservations or retentions of title under agreements with
     suppliers entered into in the ordinary course of business), (iv) all
     obligations, other than intercompany items, of such Person issued or
     assumed as the deferred purchase price of property or services purchased by
     such Person which would appear as liabilities on a balance sheet of such
     Person, (v) all Debt of others secured by (or for which the holder of such
     Debt has an existing right, contingent or otherwise, to be secured by) any
     Lien on, or payable out of the proceeds of production from, property owned
     or acquired by such Person, whether or not the obligations secured thereby
     have been assumed, (vi) all Guaranty Obligations of such Person, (vii) the
     principal portion of all Capital Lease Obligations, (viii) all obligations
     of such Person in respect of interest rate protection agreements, foreign
     currency exchange agreements, or other interest or exchange rate or
     commodity price hedging agreements, (ix) the maximum amount of all
     performance and standby letters of credit issued or bankers' acceptances
     facilities created for the account of such Person and, without duplication,
     all drafts drawn thereunder (to the extent unreimbursed), (x) all preferred
     stock issued by such Person and required by the terms thereof to be
     redeemed, or for which mandatory sinking fund payments are

                                       2
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     due, by a fixed date, and (xi) any other item of indebtedness or liability
     that would be reflected on the liabilities side of a balance sheet of such
     Person in accordance with GAAP. Notwithstanding the foregoing, Debt shall
     not include intercompany items involving members of the Arrow Group on both
     sides of a transaction, guarantees of debt obligations of other Borrowers
     to the extent the primary obligations are already included as Debt, and
     contingent liabilities under foreign currency hedge agreements with or
     approved by the Lender.

          3.   DEBT COVENANT Section 6.2(c) of the Agreement is hereby amended
and restated to read in its entirety as follows:

               "(c) Other Debt not to exceed Seventy-Five Million Dollars
($75,000,000) in the aggregate; and".

          4.   DEFAULT UNDER OTHER OBLIGATIONS. Section 7.1(d) of the Agreement
is hereby amended and restated to read in its entirety as follows:

               (d) " DEFAULT UNDER OTHER OBLIGATIONS. The Borrowers or any
Subsidiary:

                    (i) default in any payment of principal of or interest on
     any obligations for borrowed money (other than under the Notes) or for the
     deferred purchase price of property beyond any period of grace provided
     with respect thereto if the outstanding balance of such obligations exceeds
     One Million Dollars ($1,000,000); or

                    (ii) default in the performance of any other agreement, term
     or condition contained in any such obligation or in any agreement relating
     thereto, if the effect of such default is to cause, or to permit the holder
     or holders of such obligation (or a trustee on behalf of such holder or
     holders) to then cause, such obligation to become due prior to its stated
     maturity and the outstanding balance of such obligation exceeds One Million
     Dollars ($1,000,000).

          5.   NOTICES. The notice provision of Section 8.2 of the Agreement is
modified so that copies of notices to the Borrowers shall also be sent to Barley
Snyder, 501 Washington Street, P.O. Box 942, Reading, Pennsylvania 19603-0942,
Attention: Timothy G. Dietrich.

          6.   PARTICIPATIONS. The following sentence is hereby added at the end
of Section 8.6 of the Agreement:

               "Notwithstanding the foregoing, the Lender shall not participate
with other lenders in the Loans and Loan Documents without the prior written
consent of the Borrowers, which consent shall not be unreasonably withheld."

          7.   Arbitration; Waivers. Section 8.15 of the Agreement is hereby
deleted and replaced in its entirety with the following:

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         "8.15 WAIVER OF DAMAGES AND JURY TRIAL.

               (a) Each party agrees that it shall not have a remedy of punitive
          or exemplary damages against any other party in any dispute,
          proceeding or controversy (each, a "Dispute") arising out of,
          connected with or relating to this Agreement, and hereby waives any
          right or claim to punitive or exemplary damages it has now or which
          may arise in the future in connection with any Dispute.

               (b) The Borrowers expressly waive any right to a trial by jury in
     any Dispute."

          8.   REPRESENTATIONS AND WARRANTIES. As a material inducement for the
Lender to enter into this Second Amendment, the Borrowers make the following
representations and warranties to the Lender and acknowledge the Lender's
justifiable reliance thereon:

            (a)  No Default or Event of Default has occurred.

            (b)  All representations and warranties previously made to the
Lender by the Borrowers remain true, accurate, and complete.

            (c)  The Agreement, as modified and amended hereby, is the valid and
binding obligation of the Borrowers and is fully enforceable in accordance with
all stated terms.

          9.   BINDING EFFECT. This Second Amendment shall be binding upon and
shall inure to the benefit of the parties hereto and their respective successors
and permitted assigns.

          10.  COSTS AND EXPENSES. Without limiting the generality of the
provisions of the Agreement, the Borrower shall reimburse the Lender for its
out-of-pocket expenses, including counsel fees, incurred by the Lender in
connection with the development, preparation, negotiation, and enforcement of
this Second Amendment and all documents executed in connection herewith.

          11.  EFFECTIVE DATE. This Second Amendment shall be operative and
effective when the Lender has executed this Second Amendment.

          12.  RATIFICATION. Except as expressly modified and amended herein,
the Agreement and all other Loan Documents are hereby ratified and affirmed, and
the Borrowers expressly ratify and affirm all terms and provisions of the Loan
Documents, including all warrants of attorney to confess judgment as set forth
in the Loan Documents.

          13.  TERMS CONSISTENT. To the extent that any of the terms or
provisions set forth in the Loan Documents are inconsistent with any of the
terms or provisions hereof, the terms and provisions of this Second Amendment
shall control. References in any of the Loan Documents to the Agreement shall be
deemed references to the Agreement as

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amended, and references in any of the Loan Documents to any defined terms that
have been amended shall be deemed references to such defined terms as amended.

          14.  EXECUTION IN COUNTERPARTS. This Second Amendment may be executed
in any number of counterparts with the same effect as if the signatures thereto
and hereto were upon the same instrument, but all of such counterparts taken
together shall be deemed to constitute one and the same instrument.

          15.  FURTHER ASSURANCES. The Borrowers shall immediately execute and
deliver to the Lender any documents or instruments requested by the Lender from
time to time to further evidence, effectuate, secure or carry out the terms of
this Second Amendment or the Loan Documents.

          16.  ACKNOWLEDGMENTS. The Borrowers acknowledge, represent, warrant
and covenant that they do not have, and have never had, any defense to payment
or performance of any of their obligations under the Agreement and Loan
Documents or any claim, right or cause of action whatsoever, in law or equity,
against the Lender arising under the Agreement or the Loan Documents. The
Borrowers further represent, warrant and covenant that the Lender has not caused
them to suffer any damage, loss, liability, expense or obligation of any nature
whatsoever arising under the Agreement or the Loan Documents.


                              CONTINUED ON PAGE 6.






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     IN WITNESS WHEREOF, the parties hereto have caused this Second Amendment to
be duly executed as of the day and year Second above written.

                                    ARROW INTERNATIONAL, INC.

                                    By:    /s/ Frederick J. Hirt
                                           ---------------------
                                           Name: Frederick J. Hirt
                                           Title: Vice President-Finance & Chief
                                                  Financial Officer

                                    Attest: /s/ Philip B. Fleck
                                            -------------------
                                            Name: Philip B. Fleck
                                            Title: President & Chief Operating
                                            Officer

                                    ARROW MEDICAL PRODUCTS, LTD.

                                    By:     /s/ Frederick J. Hirt
                                            ---------------------
                                            Name: Frederick J. Hirt
                                            Title: Treasurer

                                    Attest: /s/ Philip B. Fleck
                                            -------------------
                                            Name: Philip B. Fleck
                                            Title: Vice President

                                    ARROW DEUTSCHLAND GMBH

                                    By:     /s/ Frederick J. Hirt
                                            ---------------------
                                            Name: Frederick J. Hirt
                                            Title: Treasurer

                                    Attest: /s/ Philip B. Fleck
                                            -------------------
                                            Name: Philip B. Fleck
                                            Title: Vice President



                     TWO ADDITIONAL SIGNATURE PAGES FOLLOW:


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                                    ARROW IBERIA, S.A.

                                    By:     /s/ Frederick J. Hirt
                                            ---------------------
                                            Name: Frederick J. Hirt
                                            Title: Treasurer

                                    Attest: /s/ Philip B. Fleck
                                            -------------------
                                            Name: Philip B. Fleck
                                            Title: Vice President

                                   ARROW INTERNACIONAL DE MEXICO, S.A. DE C.V.

                                    By:     /s/ Frederick J. Hirt
                                            ---------------------
                                            Name: Frederick J. Hirt
                                            Title: Treasurer

                                    Attest: /s/ Philip B. Fleck
                                            -------------------
                                            Name: Philip B. Fleck
                                            Title: Vice President

                                    ARROW HELLAS COMMERCIAL A. E.

                                    By:     /s/ Frederick J. Hirt
                                            ---------------------
                                            Name: Frederick J. Hirt
                                            Title: Treasurer

                                    Attest: /s/ Philip B. Fleck
                                            -------------------
                                            Name: Philip B. Fleck
                                            Title: Vice President

                                    ARROW HOLLAND MEDICAL PRODUCTS B.V.

                                    By:     /s/ Frederick J. Hirt
                                            ---------------------
                                            Name: Frederick J. Hirt
                                            Title: Treasurer

                                    Attest: /s/ Philip B. Fleck
                                            -------------------
                                            Name: Philip B. Fleck
                                            Title: Vice President


                     ONE ADDITIONAL SIGNATURE PAGE FOLLOWS:

                                       7
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                                    ARROW INTERNATIONAL CR, A.S.

                                    By:   /s/ Frederick J. Hirt
                                          ---------------------
                                          Name: Frederick J. Hirt
                                          Title: Treasurer

                                    By:   /s/ Philip B. Fleck
                                          -------------------
                                          Name: Philip B. Fleck
                                          Title: Vice President

                                    ARROW ITALY, S.R.L.

                                    By:   /s/ Frederick J. Hirt
                                          ---------------------
                                          Name: Frederick J. Hirt
                                          Title: Director

                                    By:   /s/ John C. Long
                                          ----------------
                                          Name: John C. Long
                                          Title: Director

                                                          ("Borrowers")


                                    WACHOVIA BANK, NATIONAL ASSOCIATION

                                    By
                                      ------------------------------------------
                                          Name:
                                          Title:

                                    WACHOVIA BANK, NATIONAL
                                    ASSOCIATION, LONDON BRANCH

                                    By
                                      ------------------------------------------
                                          Name:
                                          Title:

                                                          ("Lender")

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