Cavo-caval and porto-caval anastomoses are essential collateral venous pathways connecting the systemic venous system (superior and inferior vena cava) with the portal venous circulation. These anastomoses become functionally significant in pathological conditions such as portal hypertension, hepatic cirrhosis, and inferior vena cava obstruction. The most clinically important regions include the esophageal, rectal, paraumbilical, and retroperitoneal zones, where venous dilation may lead to severe complications such as variceal bleeding, hemorrhoids, and caput medusae. This article evaluates the anatomical organization, embryological development, and clinical relevance of these venous connections. Portal hypertension affects approximately 70–80% of patients with advanced liver cirrhosis, while esophageal varices occur in nearly half of these cases. Mortality from variceal bleeding remains high, reaching 15–30% in acute episodes. [3,11,7,18]