[Abstract]Cavernous transformation of the portal vein (CTPV) is a complex pathological condition characterized by the formation of cavernous venous collaterals secondary to portal vein obstruction caused by various etiologies, which often leads to portal hypertension and its associated complications. This disease features diverse causes, intricate pathological mechanisms, multidisciplinary involvement in clinical management, and considerable challenges in diagnosis and treatment. In recent years, the rapid advancement of imaging techniques and the widespread adoption of the multidisciplinary team model have markedly improved the early diagnostic rate and treatment accuracy of CTPV. However, numerous controversies remain regarding its surgical indications, therapeutic strategies, and long-term management to date. This review focuses on the etiology, clinical manifestations, imaging features, and recent therapeutic advances of CTPV, with particular emphasis on the optimization of multidisciplinary diagnostic and therapeutic strategies as well as the latest research findings. It aims to provide a systematic and practical reference for clinical practice, promote individualized comprehensive treatment, and ultimately improve the prognosis and quality of life of patients.