Sediment is an important part of aquatic systems, which plays a vital role in transporting and storing metals. Due to its abundance, persistence, and environmental toxicity, heavy metal pollution has always been one of the hot spots in the world. In this article, the state-of-art ex situ remediation technology for metal-contaminated sediments is elaborated, including sediment washing, electrokinetic remediation (EKR), chemical extraction, biological treatment, as well as encapsulating pollutants by adding some stabilized/solidified materials. Furthermore, the progress of sustainable resource utilization methods, such as ecosystem restoration, construction materials (e.g., materials fill materials, partition blocks, and paving blocks), and agriculture use are reviewed in detail. Finally, the pros and cons of each technique are summarized. This information will provide the scientific basis for selecting the appropriate remediation technology in a particular scenario.