The AS-PAD Score Predicts Significant Peripheral Artery Disease and Is Associated with Femoral Access-Site Closure...

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 (≥50% stenosis), which were incorporated into the AS-PAD Score. The Score integrates age >75 years, diabetes mellitus, BMI ≥25 kg/m², Lp(a) >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:1.05-5.70; p = 0.039) and diabetes (OR 3.18, 95% CI:1.29-7.83; p = 0.012) were independently associated with significant PAD, while BMI ≥25 kg/m² showed an inverse association. Elevated Lp(a) (>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.