Purpose In the Fiji Islands the number of major lower limb amputations being performed has reached epidemic proportions. At the Colonial War Memorial Hospital (CWMH) this number has exceeded 300 each year over the past decade. The question has been asked of whether pre-emptive treatment of lower limb artery disease by endovascular intervention might have a role. The profile of lower limb arterial disease in the Fijian population is unknown, and this study was undertaken to define such need. Methodology A cross-sectional study was conducted at CWMH, Suva, Fiji. Adults with a prior unilateral lower-limb amputation underwent duplex ultrasound of the contralateral limb from the common femoral artery to the ankle. PAD was defined as ≥50% stenosis (peak systolic velocity ratio ≥2.0) or occlusion. Disease was classified as femoral–popliteal, tibial, or combined. Lesions were designated "consider for intervention" when judged anatomically suitable for endovascular therapy within the local service context. Results Forty-eight adults were enrolled (mean age 58 years; 97.9% with diabetes). Most index amputations were sepsis-related below-knee procedures within six months of assessment. Clinically, 27.1% of contralateral limbs had ulceration and only 41.7% had normal sensation. Duplex ultrasound demonstrated PAD in 54.2%; tibial-only disease accounted for 31.3%, femoral–popliteal-only for 4.2%, and combined disease for 18.8%. Approximately half of PAD-positive limbs were considered potentially amenable to endovascular intervention. Conclusion Amputation rates for diabetic foot disease are substantially higher in centres across the South Pacific than those observed in high income countries. The identification of remedial lower-limb arterial disease in this cohort of Fijian amputees has provided the impetus to develop an endovascular service in the country, managed by local surgeons under the mentorship of Australian vascular surgical colleagues.