{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T11:17:23Z","timestamp":1783336643371,"version":"3.54.6"},"reference-count":38,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Patients with severe aortic stenosis (AS) frequently present with concomitant peripheral artery disease (PAD), which complicates transcatheter aortic valve implantation (TAVI) and increases the risk of vascular complications. Early identification of significant PAD may facilitate optimized procedural planning and risk stratification. This study aimed to develop and internally validate a clinical score for estimating the likelihood of significant PAD in patients with severe AS undergoing TAVI evaluation and to exploratorily assess its association with femoral access-site closure-device failure after TAVI. Materials and Methods: In this retrospective study, 138 patients with severe AS (124 undergoing TAVI) were evaluated. Logistic regression analyses identified independent predictors of significant PAD (\u226550% stenosis), which were incorporated into the AS-PAD Score. The Score integrates age &gt;75 years, diabetes mellitus, BMI \u226525 kg\/m2, Lp(a) &gt;50 mg\/dL (105 nmol\/L), and Fontaine clinical stage. Model performance was assessed using receiver operating characteristic (ROC) analysis and internally validated using bootstrap resampling and stratified five-fold cross-validation. Vascular complications were adjudicated according to VARC-3 criteria. Results: The AS-PAD Score demonstrated good discriminatory performance, with an AUROC of 0.804. Advanced age (OR 2.43, 95% CI:1.05\u20135.70; p = 0.039) and diabetes (OR 3.18, 95% CI:1.29\u20137.83; p = 0.012) were independently associated with significant PAD, while BMI \u226525 kg\/m2 showed an inverse association. Elevated Lp(a) (&gt;50 mg\/dL) remained independently associated with significant PAD. Internal validation using bootstrap resampling and stratified five-fold cross-validation demonstrated consistent model performance. Femoral access-site closure-device failure occurred more frequently among patients classified as intermediate or high risk by the AS-PAD Score compared with low-risk patients. Conclusions: The AS-PAD Score may serve as an adjunctive clinical tool for estimating the likelihood of significant PAD in patients with severe AS undergoing TAVI evaluation. Its association with femoral access-site closure-device failure should be interpreted as exploratory and hypothesis-generating. Further external validation is required to confirm its role alongside standard CT-based vascular assessment.<\/jats:p>","DOI":"10.3390\/medicina62071293","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T08:05:38Z","timestamp":1783325138000},"page":"1293","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The\u00a0AS-PAD Score Predicts Significant Peripheral Artery Disease and Is Associated with Femoral Access-Site Closure Device Failure in Patients Undergoing TAVI"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1093-981X","authenticated-orcid":false,"given":"Uttban","family":"Gohman","sequence":"first","affiliation":[{"name":"Division of Cardiology, Angiology and Internal Emergency Medicine, Department of Medicine, Knappschaft Kliniken University Hospital Bochum, Ruhr University Bochum, 44892 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1258-6356","authenticated-orcid":false,"given":"Mohamad Amer","family":"Nashtar","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Angiology and Internal Emergency Medicine, Department of Medicine, Knappschaft Kliniken University Hospital Bochum, Ruhr University Bochum, 44892 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Liedtke","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Angiology and Internal Emergency Medicine, Department of Medicine, Knappschaft Kliniken University Hospital Bochum, Ruhr University Bochum, 44892 Bochum, Germany"},{"name":"Institute of Molecular Immunology, Ruhr University Bochum, 44801 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9030-6603","authenticated-orcid":false,"given":"Obayda","family":"Azizy","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Angiology and Internal Emergency Medicine, Department of Medicine, Knappschaft Kliniken University Hospital Bochum, Ruhr University Bochum, 44892 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rn","family":"Trippe","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Angiology and Internal Emergency Medicine, Department of Medicine, Knappschaft Kliniken University Hospital Bochum, Ruhr University Bochum, 44892 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justus","family":"Strauch","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, 44789 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9966-6886","authenticated-orcid":false,"given":"Rolf Alexander","family":"J\u00e1nosi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Electrophysiology, Heart Center Duisburg, 47169 Duisburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5768-9125","authenticated-orcid":false,"given":"Panagiotis","family":"Iliakis","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Angiology and Internal Emergency Medicine, Department of Medicine, Knappschaft Kliniken University Hospital Bochum, Ruhr University Bochum, 44892 Bochum, Germany"},{"name":"First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyriakos","family":"Dimitriadis","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7636-6725","authenticated-orcid":false,"given":"Konstantinos","family":"Tsioufis","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6069-7899","authenticated-orcid":false,"given":"Ali","family":"Canbay","sequence":"additional","affiliation":[{"name":"Division of Hepatology and Gastroenterology, Department of Medicine, Knappschaft Kliniken University Hospital Bochum, Ruhr University Bochum, 44892 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5360-0419","authenticated-orcid":false,"given":"Ingo","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Institute of Molecular Immunology, Ruhr University Bochum, 44801 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Steinmetz","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Angiology and Internal Emergency Medicine, Department of Medicine, Knappschaft Kliniken University Hospital Bochum, Ruhr University Bochum, 44892 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polykarpos Christos","family":"Patsalis","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Angiology and Internal Emergency Medicine, Department of Medicine, Knappschaft Kliniken University Hospital Bochum, Ruhr University Bochum, 44892 Bochum, Germany"},{"name":"Department of Cardiology, Angiology and Electrophysiology, Heart Center Duisburg, 47169 Duisburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1016\/S0140-6736(13)61249-0","article-title":"Comparison of Global Estimates of Prevalence and Risk Factors for Peripheral Artery Disease in 2000 and 2010: A Systematic Review and Analysis","volume":"382","author":"Fowkes","year":"2013","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1161\/CIRCRESAHA.116.303849","article-title":"Epidemiology of Peripheral Artery Disease","volume":"116","author":"Criqui","year":"2015","journal-title":"Circ. 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