64-year-old female with a 2-year history of worsening left calf claudication. Pain has become severe enough the patient is having a hard time working and staying employed. CT angiography showed a heavily calcified common femoral artery plaque causing near occlusion of the artery. Retrograde superficial femoral access with directional atherectomy was attempted but limited due to difficulty getting the cutting blade to engage the plaque. Using external compression to assist the atherectomy resulted in significant plaque removal and luminal gain. Patient had normalization of their ABI's and was able to work pain free 2 days after the procedure.