Plasma exchange, a treatment for antineutrophil antibody (ANCA)-associated vasculitis, has been used since the early 1940s. It involves extracting and storing blood in a refrigerator for a week, reducing antibody levels and serum creatinine levels. The procedure was first used in the 1970s to improve transplant life and still in 2024 to treat Goodpasture's disease. Plasma exchange can be carried out using centrifugation or filtration, with modern systems maintaining continuous control over the interface. While no evidence supports plasma exchange in treating vasculitis-associated pulmonary bleeding, numerous non-randomized studies have advocated for its use as a standard metric. The medication is productive in managing ANCA-associated vasculitis, resulting in profound renal failure and reduced dependence on dialysis. The establishment of an extensive organized trial network in Europe, the USA, Canada, and Australia has played a significant role in the advancement of top-notch, researcher-led, collaborative trials such as PEXIVAS.