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Peripheral artery disease (PAD) is a disease of the systemic arterial tree and is a growing concern globally. It commonly affects the lower extremities and leads to increased mortality and morbidity due to its known association with coronary artery disease and strokes. Over the past several decades, advanced imaging has become a major part in the diagnosis and management of PAD, but there is still no consensus agreement as to the preferred initial imaging test of choice. Over the years, several different trials, reviews, and analyses have compared the three primary imaging modalities in PAD: ultrasound, magnetic resonance angiography (MRA), and computed tomographic angiography (CTA). Overall, the literature suggests that while MRA may have a slight advantage in accuracy, CTA may be the better initial test of choice due to patient comfort and cost-effectiveness. However, each imaging modality has its own risks and contraindications that should be carefully reviewed prior to utilization. This is a review of the current available literature comparing the use of ultrasound, MRA, and CTA in the diagnosis and management of lower extremity PAD.