OBJECTIVE: The objective of this study was to explore the trends associated with inpatient procedural medical care costs the first ten years after initial inpatient confirmation of peripheral arterial disease (PAD). METHODS: A retrospective review of the computer records of all the beneficiaries of the Department of Defense health care system was conducted, and over 8,000 subjects with an initial inpatient confirmation of PAD between 1/1/80 and 12/31/85 were reviewed for ten years following the initial visit. 1997 Medicare 50th percentile reimbursement costs for PAD related procedures were collected and used in the analysis. Opportunity costs associated with the inpatient procedures performed were also calculated by utilizing the Bureau of Labor and Statistics hospital services price index, and future value calculations. RESULTS: Costs for PAD-related invasive procedures rose gradually over the ten years after initial diagnosis, while the cost of examination procedures was highest in the 1st, 5th, and 10th years. Invasive procedures made up 85.5% of the total ten-year procedural costs, with 10 specific ICD-9-CM codes accounting for 90% of those costs. Four examination procedures represented 90% of all examination procedure costs. Procedures involving vascular bypass had the highest aggregate costs associated with invasive procedures, and procedures involving arteriography had the highest aggregate costs associated with examination procedures. The institutions opportunity costs were over one quarter a million 1997 U.S. dollars at a 10 percent investment rate. CONCLUSION: The results of this research provide a foundation for understanding the ten-year trends associated with PAD-related inpatient procedural costs. These results suggest that reducing procedures involving bypass and arteriography would have the greatest impact on PAD-related procedural costs.