How Do I Rotate Shape or Text Box, and Add Images In an Existing PDF Document?

Gary – When reviewing and editing a PDF document there are many great tools in Preview. We can add text boxes, shapes, shapes with text in them, and we can add highlights, underlines, strike-throughs, etc. What I can’t seem to do is to rotate a shape, or a shape with text, or a text box. So, my next approach was to try to paste a PDF of my desired content and orientation into a PDF. Couldn’t find a way to do that either. Do you have any low cost suggestions?
I want to do this because I would like to show the author of the PDF, who has asked for my review, what my suggestions will look like by modifying the original draft document. I don’t need to edit the text, but would like to add some graphics as overlays.
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Jerry