Background: Vascular disease prevalence and mortality are increasing across Oceania, yet access to vascular and endovascular surgical care remains highly inequitable, particularly in low- and middle-income countries (LMICs). Limited data exist on service availability and barriers to care, limiting efforts to strengthen vascular services in underserved regions. Method: The Global Vascular Companionship conducted a mixed-methods cross-sectional survey of surgeons, healthcare personnel, and health ministry representatives across LMICs in Oceania, also including all sovereign nations and non-sovereign territories with populations over 100,000. Contacts were identified through professional networks and public directories. Datapoints were collected on service availability, workforce capacity, and barriers to care, and supplemented by an online search. Descriptive and thematic analyses were performed. Results: Sixteen nations were identified, with hospital numbers ranging from one to more than ten per country. Forty-nine phone numbers and 137 email addresses were contacted, yielding responses from 30 individuals. Of these, 22 completed surveys, representing 16 hospitals. Only Fiji and Guam have full-time vascular surgeons; four countries rely on visiting surgeons, while ten have no access to vascular surgeons. Thematic analysis identified system-level constraints including shortages of trained specialists, limited diagnostic imaging and endovascular equipment, inconsistent access to consumables, inadequate theatre capacity, and insufficient funding. Workforce training was most frequently identified as the intervention with greatest potential impact. Conclusion: Vascular surgical care across Oceania is profoundly inequitable, with most nations lacking sustainable local services. Targeted workforce-focused capacity building, supported by appropriate resources and regional collaboration, is urgently needed to improve equitable access to care in Pacific nations.