Purpose of Review <p>The purpose of this manuscript is to provide an overview of plaque modification technologies available to the interventionalist treating peripheral arterial disease.</p> Recent Findings <p>Conventional balloon angioplasty continues to be an often-used resource. However, more specialized balloons, including drug-coated, cutting and scoring balloons, play a key role in vessel preparation. Though not demonstrated in the literature, their theoretical benefit includes improved drug delivery and uniform vessel dilation. Atherectomy comes in many forms as multiple randomized control trials have demonstrated its superiority to conventional angioplasty. Intravascular lithotripsy has taken a foothold in the treatment of severe calcific disease with trials to support their effectiveness.</p> Summary <p>Multiple plaque modification modalities are available in the vascular surgeon’s arsenal. A thorough understanding of their mechanism of action is paramount to tailoring their use to various lesion types.</p>