PURPOSE: Major amputation is a life-changing complication of diabetes-related foot disease (DRFD). Perfusion assessment and prompt revascularisation are essential components of limb salvage. Inequities exist for major amputation secondary to DRFD in Aotearoa New Zealand (AoNZ), and may be driven by inequities in access to revascularization. This study aims to examine regional and ethnic inequities in revascularisation for DRFD in AoNZ. METHODS: The Virtual Diabetes Register identified diabetic individuals alive on 1 January 2016. Exclusion criteria were non-residents of AoNZ, and prior major limb amputation or revascularisation. Public hospital discharge data identified procedures from 2016-23. Primary outcomes were major amputation, and open and endovascular lower limb revascularisation prior to amputation. Univariate and risk-adjusted analyses were performed, with patients stratified by their domiciled region. RESULTS: Of 256,807 patients (49.0% female, 16.2% Māori) included, 1,234 patients (0.5%) underwent major amputation. Males (aOR 2.2, 95% CI 1.9-2.4), Māori (aOR 1.5, 95% CI 1.3-1.7), and high socioeconomic deprivation (aOR 1.8, 95% CI 1.4-2.3) had higher risk-adjusted odds of major amputation. There was threefold regional variation in major amputation rates (unadjusted 0.3-1.1%, risk-adjusted 0.3-1.0%). For patients undergoing major amputation, 45.1% had revascularisation prior. There was threefold variation (16.7-58.3% unadjusted, 17.1-58.6% risk-adjusted), with geographic inequity between the centralised area of Waitematā (risk adjusted revascularization rate 49.1%) compared to the regional/remote area of Tairāwhiti (17.1%). Māori were more likely to have revascularisation prior to major amputation (aOR 1.4, 95% CI 1.0-1.8); a difference present for endovascular but not open surgery. CONCLUSION: Regional variations in revascularization prior to DFRD-related major amputation may represent geographic inequities in access to a Vascular Surgery service in AoNZ.