Cerebral amyloid angiopathy (CAA) is a common cerebral small vessel disease in the elderly, characterized primarily by the deposition of amyloid β (Aβ) in the leptomeninges and small vessels of the cortex. Although the presence of Aβ has been confirmed in the venules of both CAA patients and animal models, current research on CAA mainly focuses on the deposition of Aβ in arteries and capillaries, with relatively little attention given to veins. Recently, as research has advanced, the potential pathological role of veins in Alzheimer’s disease and cerebral small vessel diseases has gradually gained recognition. However, the pathological mechanisms by which veins contribute to the formation and progression of CAA remain unclear. Therefore, this review will provide an in-depth analysis of the clinical manifestations and potential pathological mechanisms of CAA from the perspective of veins, aiming to offer new insights for early clinical intervention in CAA.