Vision-language models (VLMs) show remarkable performance in multimodal tasks. However, excessively long multimodal inputs lead to oversized Key-Value (KV) caches, resulting in significant memory consumption and I/O bottlenecks. Previous KV quantization methods for Large Language Models (LLMs) may alleviate these issues but overlook the attention saliency differences of multimodal tokens, resulting in suboptimal performance. In this paper, we investigate the attention-aware token saliency patterns in VLM and propose AKVQ-VL. AKVQ-VL leverages the proposed Text-Salient Attention (TSA) and Pivot-Token-Salient Attention (PSA) patterns to adaptively allocate bit budgets. Moreover, achieving extremely low-bit quantization requires effectively addressing outliers in KV tensors. AKVQ-VL utilizes the Walsh-Hadamard transform (WHT) to construct outlier-free KV caches, thereby reducing quantization difficulty. Evaluations of 2-bit quantization on 12 long-context and multimodal tasks demonstrate that AKVQ-VL maintains or even improves accuracy, outperforming LLM-oriented methods. AKVQ-VL can reduce peak memory usage by 2.13x, support up to 3.25x larger batch sizes and 2.46x throughput.