The “diffuse A-V shunt” observed in the spleen of patients with chronic liver disease and portal hypertension, as detected by Doppler ultrasound, is partially attributed to increased passive splenic arterial blood flow. However, the underlying mechanism for this increase remains unclear. In this study, we investigated the potential involvement of the hepatic artery by comparing hepatic arterial blood flow between patients with and without intrasplenic A-V shunts. A total of 224 ultrasound datasets from 184 patients with chronic liver disease were analyzed. The hepatic artery resistance index (RI) was significantly higher in patients with positive intrasplenic A-V shunts (n＝37, 0.795±0.094) than in those without (n＝187, 0.708±0.084) (p＜0.001). Notably, in all six cases where the intrasplenic A-V shunt became negative during follow-up, the RI was lower than when the shunt was present. In conclusion, hepatic arterial peripheral vascular resistance was increased in patients with positive intrasplenic A-V shunts. This increased resistance may contribute to the development of intrasplenic A-V shunts and may also represent a physiological response to portal hypertension caused by the shunt. The hemodynamic interplay between the liver and spleen in this context suggests a pathophysiological cycle that could be described as a “negative spiral”.