Superior vena cava (SVC) syndrome is a constellation of clinical signs and symptoms secondary to obstruction of the SVC. The most common etiology is malignancy. However, the incidence of device-related SVC syndrome is increasing. The current management for device-related SVC syndrome includes open surgical intervention, endovascular repair, or systemic anticoagulation. We present a case of a 95-year-old female who developed SVC syndrome due to thrombosis secondary to pacemaker leads. She was treated conservatively due to her frailty and comorbid conditions. We discuss the evolving etiology of SVC syndrome, the most common presenting signs and symptoms, and a variety of potential treatments for non-malignant SVC syndrome. We also provide an example of when conservative management for chronic device-related SVC syndrome is appropriate.